THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

LOS  ANGELES 

GIFT  OF 


Mrs.    George  Gore 


NATURE  IN  DISEASE, 


ILLUSTRATED   IN 


VARIOUS   DISCOURSES  AND   ESSAYS, 


TO    WHICH    ARK    ADDED 


MISCELLANEOUS  WRITINGS, 


CHIEFLY    ON    MEDICAL    SUBJECTS. 


BY  JACOB    BIGELOW,   M.  D. 

PHYSICIAN   AXD    LECTCUER    ON   CLIXICAL   MEDICIJfE    IV  THE   MASSACHCSE 

GSNEKAT.  HOSPITAL  ;    PROFESSOR  OF   MATERIA  MKDICA  IN   HARVARD 

UXI7ERSITT  ;     PKESIDEXT  OF   THS   AMERICAS  ACADEMY   OF 

ARTS    AND  SCIENCES  J     ASD    LATE   PKESIDKST  OF 

THE  1IASSACUCSEITS   MF.DICAL  SOCIETY. 


BOSTON: 
TICK  NOR   AND    FIELDS. 

MDCCCL1V. 


Entered  according  to  Act  of  Congress,  in  the  year  1854,  by 

TICK  NOR     AND     FIELDS, 
In  the  Clerk's  Office  of  the  District  Court  of  the  District  of  Massachusetts. 


BOSTON: 

ASI)    TOKltr,    PKIXTKRS 


-R 

in 


PREFACE. 

IT  is  observable  to  many  physicians,  that  a  change  in  the 
mode  of  regarding  the  treatment  of  disease  has  come  over 
the  msdical  world  in  this  city  and  in  various  parts  of  the 
United  States,  during  the  last  quarter  of  a  century.  In 
certain  cases  a  practice  of  watching,  guiding,  and  trusting 
the  salutary  indications  of  nature,  has  taken  the  place  of 
more  active  interferences  of  art.  Those  men  whose  medical 
career  began  at  a  period  antecedent  to  that  which  has  been 
named,  will  recollect  that  the  course  then  most  prevalent 
among  the  profession  consisted  in  energetic  and  sometimes 
annoying  and  painful  applications  of  supposed  remedies, 
from  the  beginning  to  the  end  of  diseases,  whether  those 
diseases  were  amenable  to  such  treatment,  or  totally  incapa- 
ble of  being  influenced  by  them.  And,  in  some  instances, 
such  active  measures  were  promoted  by  influential  teachers 
of  medical  science,  in  the  great  schools  of  our  country. 

Nearly  twenty  years  ago,  the  Discourse  on  Self-limited 
Diseases,  which  stands  at  the  head  of  this  volume,  was  de- 


922421 


iy  PREFACE. 

livered  before  the  Massachusetts  Medical  Society,  at  their 
annual  meeting,  as  an  expression  of  opinions  I  had  been  led 
to  entertain,  as  to  the  influence  of  treatment  on  the  event 
of  some  morbid  affections.  Subsequent  observation  has  not 
tended  to  shake  these  opinions  ;  and  I  have  had  the  satisfac- 
tion to  believe  that  many  of  my  medical  friends,  for  whose 
judgment  the  public  entertain  the  highest  respect,  have  ar- 
rived at  similar  conclusions.  As  science  has  advanced,  some 
revision  has  become  necessary  of  this  as  well  as  of  some 
other  essays  written  long  ago.  But  the  general  truth  of  the 
positions  then  assumed  has  not  been  contradicted  by  later 
experience  of  competent  observers  in  the  profession. 

The  exclusive  pursuit  of  any  profession  frequently  tends 
to  an  urtdue  exaggeration  of  its  powers.  What  we  have 
been  early  taught  to  accept  on  authority,  and  what  we  have 
been  accustomed  habitually  to  announce  to  others,  may  be- 
come engrafted  on  our  own  belief,  so  as  to  constitute  an 
unquestioned  rule  of  practice.  The  necessity  is,  on  this 
account,  more  imperative,  that  inquirers  for  truth  should 
divest  themselves  of  personal  considerations,  and  seek  for 
rules  of  practice  which  are  based  on  enlightened  experience, 
and  impartial  and  reliable  evidence. 

I  have  given  the  title  "  Nature  in  Disease"  to  the  present 
collection  of  discourses  and  disquisitions,  because  a  number 
of  the  principal  articles  in  its  contents  bear  directly  on  that 


PREAFCE.  V 

subject.  But  I  have  taken  advantage  of  the  same  occasion 
to  incorporate  in  this  small  volume  some  other  miscellaneous 
papers,  chiefly  on  medical  subjects,  written  or  published  at 
various  times,  during  a  long  and  active  professional  life. 

J.  B. 

BOSTON,  Nov.  1,  1854. 


ERRATA. 

'Page    8,  tine  8  from  top,        for  give,  read  gives. 

"      19,     "    5  from  bottom,   "  III.  616,  »     I.  651. 

"      79,    "  10  from  top,          "  affctions,          "     affections. 
•"   335,     "     6  from  bottom,   "  Grat  Britain,   "     Great  Britain. 
"    235,    "    3     "         "  "  do  novo,          "     tie  novo. 


CONTENTS. 


- 

ON  SELF-LIMITED  DISEASES        .....         1 

II. 
ON  THE  TREATMENT  OF  DISEASE       ....       59 

III. 

PRACTICAL  VIEWS  OF  MEDICAL  EDUCATION       .         .       91 

IV. 

REPORT  ON  HOMCEOPATHY  ...         .         ^101 

V. 

ON  THE  MEDICAL  PROFESSION,  AND  QUACKERY  .         .110 

VI. 

ON  GOUT  AND  ITS  TREATMENT          ....     132 

VII. 

ON  THE  TREATMENT  OE  INJURIES  OCCASIONED  BY  FIRE 

AND  HEATED  SUBSTANCES  .         .         .         .146 

VIII. 
ON  THE  BURIAL  OF  THE  DEAD  ;  AND  THE  CEMETERY 

AT  MOUNT  AUBURN 171 

IX. 

REMARKS  AND  EXPERIMENTS  ON  PNEUMOTHORAI        .     195 


Vlll  CONTENTS. 

X. 

ON  THE  PHARMACOPEIA  OF  THE  UNITED  STATES        .    231 

XL 

ON  THE  MUCUNA  PRURIENS  :  WITH  REMARKS  ON  THE 

IRRITABILITY  OF  DIFFERENT  TEXTURES        .        .    266 

XII. 

ON  THE  POISONOUS  EFFECTS  OF  THE  AMERICAN  PAR- 
TRIDGE, OR  RUFFED  GROUSE  ....  272 

XIII. 
ON  COFFEE  AND  TEA  ;  AND  THEIR  MEDICINAL  EFFECTS    289 

XIV. 

REPORT  ON  THE  ACTION  OF  COCHITUATE  WATER  ON 
LEAD  PIPES  ;  AND  THE  INFLUENCE  OF  THE  SAME 
ON  HEALTH  .  .  .  .  .  .315 

XV. 

ON  THE  HISTORY  AND  USE  OF  TOBACCO    .        .        .323 

XVI. 

ON  THE  EARLY  HISTORY  OF  MEDICINE      .         .         .     337 

XVII. 

ADDRESS  DELIVERED  BEFORE  THE  AMERICAN  ACADEMY 
OF  ARTS  AND  SCIENCES,  AT  THE  OPENING  OF  THEIR 
COURSE  OF  LECTURES,  OCTOBER  27,  1652.  .  358 


SELF-LIMITED   DISEASES 


A     DISCOURSE      DELIVERED     BEFORE      THE      MASSACHUSETTS 
MEDICAL    SOCIETY,     AT    THEIR    ANNUAL     MEETING,    MAY 

27TH,    1835. 

[At  the  beginning  of  this  discourse,  the  customary  obituary 
notice  was  taken  of  eminent  members  of  the  society,  de- 
ceased during  the  previous  year.] 

THE  death  of  medical  men  is  an  occurrence 
which  eminently  demands  our  attention,  for  it 
speaks  to  us  of  our  science,  and  of  ourselves. 
It  reminds  us,  that  we,  in  turn,  are  to  become 
victims  of  the  incompetency  of  our  own  art.  It 
admonishes  us,  that  the  sphere  of  our  profession- 
al exertions  is  limited,  at  last,  by  insurmount- 
able barriers.  It  brings  with  it  the  humiliating 
conclusion,  that  while  other  sciences  have  been 
carried  forward,  within  our  own  time  and  al- 
most under  our  own  eyes,  to  a  degree  of  un- 
precedented advancement,  Medicine,  in  regard 
1 


A  SELF-LIMITED    DISEASES. 

to  some  of  its  professed  and  most  important 
objects,  is  still  an  ineffectual  speculation.  Ob- 
servations are  multiplied,  but  the  observers  dis- 
appear, and  leave  their  task  unfinished.  We 
have  seen  the  maturity  of  age,  and  the  ardent 
purpose  of  youth,  called  off  from  the  half  cul- 
tivated field  of  their  labors,  expectations  and 
promise.  It  becomes  us  to  look  upon  this  deep- 
ly interesting  subject  with  unprejudiced  eyes, 
and  to  endeavor  to  elicit  useful  truth  from  the 
great  lesson  that  surrounds  us. 

In  comparing  the  advances  which  have  been 
made,  during  the  present  age,  in  different  de- 
partments of  Medical  science,  we  are  brought  to 
the  conclusion,  that  they  have  not  all  been  cul- 
tivated with  equally  satisfactory  success.  Some 
of  them  have  received  new  and  important  illus- 
trations from  scientific  inquiry,  but  others  are 
still  surrounded  with  their  original  difficulties. 
The  structure  and  functions  of  the  human  body, 
the  laws  which  govern  the  progress  of  its  dis- 
eases, and  more  especially  the  diagnosis  of  its 
morbid  conditions,  are  better  understood  now, 
than  they  were  at  the  beginning  of  the  present 
century.  But  the  science  of  therapeutics,  or  the 


SELF-LIMITED    DISEASES. 


branch  of  knowledge  by  the  application  of  which 
physicians  are  expected  to  remove  diseases,  has 
not,  seemingly,  attained  to  a  much  more  eleva- 
ted standing  than  it  formerly  possessed.  The 
records  of  mortality  attest  its  frequent  failures, 
and  the  inability  to  control  the  event  of  diseases, 
which  at  times  is  felt  by  the  most  gifted  and 
experienced  practitioners,  give  evidence  that, 
in  %iany  cases,  disease  is  more  easily  under- 
stood, than  cured. 

This  deficiency  of  the  healing  art  is  not  justly 
attributable  to  any  want  of  sagacity  or  diligence 
on  the  part  of  the  medical  profession.  It  be- 
longs rather  to  the  inherent  difficulties  of  the 
case,  and  is,  after  abating  the  effect  of  errors  and 
accidents,  to  be  ascribed  to  the  apparent  fact, 
that  certain  morbid  processes  in  the  human 
body  have  a  definite  and  necessary  career,  from 
which  they  are  not  to  be  diverted  by  any  known 
agents,  with  which  it  is  in  our  power  to  oppose 
them.  To  these  morbid  affections,  the  duration 
of  which,  and  frequently  the  event  also,  are 
beyond  the  control  of  our  present  remedial 
means,  I  have,  on  the  present  occasion,  applied 
the  name  of  Self -limited  diseases  ;  and  it  will 


4  SELF-LIMITED  DISEASES. 

be  the  object  of  this  discourse  to  endeavor  to 
show  the  existence  of  such  a  class,  and  to  in- 
quire how  far  certain  individual  diseases  may 
be  considered  as  belonging  to  it. 

By  a  self-limited  disease,  I  would  be  under- 
stood to  express  one  which  receives  limits  from 
its  own  nature,  and  not  from  foreign  influences; 
one  which,  after  it  has  obtained  foothold  in  the 
system,  cannot,  in  the  present  state  of  our  know- 
ledge, be  eradicated,  or  abridged,  by  art, — but 
to  which  there  is  due  a  certain  succession  of 
processes,  to  be  completed  in  a  certain  time ; 
which  time  and  processes  may  vary  with  the 
constitution  and  condition  of  the  patient,  and 
may  tend  to  death,  or  to  recovery,  but  are  not 
known  to  be  shortened,  or  greatly  changed,  by 
medical  treatment. 

These  expressions  are  not  intended  to  apply 
to  the  palliation  of  diseases,  for  he  who  turns  a 
pillow,  or  administers  a  seasonable  draught  of 
water  to  a  patient,  palliates  his  sufferings ;  but 
they  apply  to  the  more  important  consideration 
of  removing  diseases  themselves  through  medi- 
cal means. 

The  existence  of  a  class  ol  diseases,  like  those 


SELF-LIMITED    DISEASES.  O 

under  consideration,  is,  to  a  certain  extent, 
aVeady  admitted,  both  by  the  profession,  and 
the  public  ;  and  this  admission  is  evinced  by  the 
use  of  certain  familiar  terms  of  expression. 
Thus,  when  people  speak  of  a  '  settled  disease,' 
or  of  the  time  of  'the  run  of  a  disease,'  it  implies, 
on  their  part,  a  recognition  of  the  law,  that 
certain  diseases  regulate  their  own  limits  and 
period  of  continuance. 

It  is  difficult  to  select  a  perfectly  satisfactory 
or  convincing  example  of  a  self-limited  disease 
from  among  the  graver  morbid  affections,  be- 
cause in  these  affections  the  solicitude  of  the 
practitioner  usually  leads  him  to  the  employ- 
ment of  remedies,  in  consequence  of  which,  the 
effect  of  remedies  is  mixed  up  with  the  phenom- 
ena of  disease,  so  that  the  mind  has  difficulty  in 
separating  them.  [Note  A.]  We  must  there- 
fore seek  for  our  most  striking  or  decisive  exam- 
ples among  those  diseases  which  are  sufficiently 
mild,  not  to  be  thought  to  require  ordinarily  the 
use  of  remedies,  and  in  which  the  natural  his- 
tory of  the  disease  may  be  observed,  divested  of 
foreign  influences.  Such  examples  are  found 
in  the  vaccine  disease,  the  chicken  pox,  and  the 


6  SELF-LIMITED    DISEASES. 

salivation  produced  by  mercury.  These  are 
strictly  self-limited  diseases,  having  their  own 
rise,  climax,  and  decline ;  and  I  know  of  no 
medical  practice  which  is  able,  were  it  deemed 
necessary,  to  divert  them  from  their  appropriate 
course,  or  hasten  their  termination.  [Note  B.] 

It  may  appear  to  some,  that  the  distinction  of 
these  diseases  from  others,  is  the  old  distinction 
of  acute  and  chronic.  Yet  on  due  inquiry,  such 
an  identification  is  not  found  to  be  sustained, 
for  there  are  some  acute  diseases  which,  we 
have  reason  to  believe,  are  shortened  by  the 
employment  of  remedies ;  while,  on  the  other 
hand,  certain  chronic  cases  of  disease  are  known 
to  get  well  spontaneously,  after  years  of  con- 
tinuance. 

If  the  inquiry  be  made,  why  one  disease  has 
necessary  limits,  while  another  is  without  them  ? 
the  reply  is  not  uniform,  nor  always  easy  to  be 
made.  Sometimes  the  law  of  the  disease  may 
be  traced  to  the  nature  of  the  exciting  cause. 
Thus  the  morbid  poison  of  measles,  or  of  small 
pox,  when  received  into  the  body,  produces  a 
self-limited  disease ;  but  the  morbid  poisons  of 
psora  and  syphilis  may  give  rise  to  others  which 


SELF-LIMITED    DISEASES.  »7 

are  not  limited,  except  by  medical  treatment. 
[Note  C.]  Sometimes,  also,  the  cause  being 
the  same,  the  result  will  depend  on  the  part, 
organ,  or  texture  which  is  affected.  Thus  if  we 
divide  with  a  cutting  instrument  the  cellular  or 
muscular  substance,  we  produce  a  self-limited 
disease,  which,  although  it  cannot  by  any  art  be 
healed  within  a  certain  number  of  days  or 
weeks,  yet  in  the  end  gets  well  spontaneously,  by 
one  process,  if  the  lips  are  in  contact,  —  and  by 
another  and  slower  process,  if  they  are  separa- 
ted.* But  if,  on  the  other  hand,  we  divide  a 
considerable  artery,  we  have  then  an  unlimited 
disease ;  and  the  hemorrhage,  or  the  aneurism, 
which  follows,  does  not  get  well,  except  through 
the  interposition  of  art. 

The  class  of  diseases  under  consideration, 
comprehends  morbid  affections,  differing  greatly 
from  each  other,  in  the  time,  place,  and  nature 
of  their  spontaneous  developments  ;  so  that 
they  may  admit  of  at  least  three  general 
subdivisions.  These  may  be  called,  1st.  The 
simple ;  in  which  the  disease  observes  a  con- 

*  la  one  case,  the  disease  is  a  solution  of  continuity  ;  in  the 
other,  a  solution  of  continuity  and  contact. 


8  SELF-LIMITED    DISEASES. 

tinuous  time,  and  mostly  a  definite  seat ;  2d, 
The  paroxysmal;  in  which  the  disease,  having 
apparently  disappeared,  returns  at  its  own 
periods ;  and  3d.  The  metastatic ;  in  which  the 
disease  undergoes  metastasis  or  spontaneous 
change  of  place.  In  the  present  state  of  our 
knowledge,  we  have  no  difficulty  in  finding 
examples  of  each  of  these  subdivisions.  There 
are  also  other  examples,  in  which  the  disease, 
although  capable  of  being  in  part  influenced  by 
medical  treatment,  still  retains  a  portion  of  its 
original  intractability,  and  has  strong  relations 
to  the  class  in  question. 

As  a  mode  of  directing  our  inquiries  toward 
these  diseases,  we  may  suspect  those  complaints 
to  be  self-limited,  in  which  it  is  observed  that 
the  unwary,  and  the  sceptical,  who  neglect  to 
resort  to  remedies,  recover  their  health  without 
them.  We  may  also  suspect  diseases  to  be  of 
this  character,  when  we  find  opposite  modes 
of  treatment  recommended,  and  their  success 
vouched  for,  by  practitioners  of  authority  and 
veracity.  We  may  moreover  attach  the  same 
suspicion  to  cases,  in  which  the  supposed  cure 
takes  place  under  chance  applications,  or  incon- 


SELF-LIMITED    DISEASES.  9 

siderable  remedies;  as  in  the  empirical  modes 
of  practice  on  the  one  hand,  and  the  minute 
doses  of  the  homo3opathic  method  on  the  other. 
Lastly,  we  may  apprehend  that  cases  are  fatally 
self-limited,*  when  enlightened  physicians  die 
themselves  of  the  diseases  which  they  had  la- 
bored to  illustrate, —  as  in  the  case  of  Corvisart, 
Laennec,  Armstrong,  and  others.  [Note  D.] 

In  proceeding  to  enumerate  more  precisely 
some  of  the  diseases  which  appear  to  me  to  be 
self-limited  in  their  character,  I  approach  the 
subject  with  diffidence.  I  am  aware  that  the 
works  of  medical  writers,  and  especially  of 
medical  compilers,  teem  with  remedies  and 
modes  of  treatment  for  all  diseases;  and  that 
in  the  morbid  affections  of  which  we  speak, 
remedies  are  often  urged  with  zeal  and  con- 
fidence, even  though  sometimes  of  an  opposite 
character.  Moreover,  in  many  places,  at  the 
present  day,  a  charm  is  popularly  attached  to 
what  is  called  an  active,  bold,  or  heroic  prac- 

*  In  the  following  article  on  the  Treatment  of  Disease,  it  has 
been  found  convenient  to  divide  diseases  into  the  curable,  the 
self-limited,  and  the  incurable.  In  a  general  sense,  however, 
the  last  term  falls  within  the  second. 


10  SELF-LIMITED    DISEASES. 

tice;  and  a  corresponding  reproach  awaits  the 
opposite  course,  which  is  cautious,  palliative, 
and  expectant.  In  regard  to  the  diseases  which 
have  been  called  self-limited,  I  would  not  be 
understood  to  deny  that  remedies  capable  of 
removing  them  may  exist ;  I  would  only  assert, 
that  they  have  not  yet  been  proved  to  exist. 

Under  the  simple  self-limited  diseases,  we 
may  class  hooping  cough.  This  disease  has  its 
regular  increase,  height,  and  decline,  occupying 
ordinarily  from  one  to  six  months,  but  in  some 
mild  cases  only  two  or  three  weeks.  During 
this  period,  medical  treatment  is  for  the  most 
part  of  no  avail.  Narcotic  appliances  may 
diminish  4he  paroxysm,  but  without  abridging 
the  disease.  After  hooping  cough  has  reached 
its  climax,  change  of  air  sometimes  appears  to 
hasten  convalescence.  Also  if  inflammatory, 
or  other  morbid  affections,  supervene  upon  the 
pure  disease,  they  may  become  subjects  for 
medical  treatment.  With  these  exceptions, 
hooping  cough  appears  to  be  a  self-limited 
disease. 

Most  of  the  class  of  diseases  usually  de- 
nominated eruptive  fevers,  are  self-limited. 


SELF-LIMITED    DISEASES.  11 

Measles,  for  example,  is  never  known  to  be 
cut  short  by  art,  or  abridged  of  its  natural 
career ;  neither  can  this  career  be  extended  or 
the  disease  kept  in  the  system  beyond  its 
natural  duration,  by  the  power  of  medicine. 
Scarlet  fever,  a  disease  of  which  we  have  had 
much  and  fatal  experience  during  the  last  three 
years,  is  eminently  of  the  same  character.  The 
reasons,  which  induce  me  thus  to  regard  it, 
are  the  following.  The  writings  of  medical 
observers  agree  in  assigning  to  it  a  common, 
or  average  period  of  duration,  and  this  is  con- 
firmed by  the  observations  of  practitioners  at 
the  present  day.  From  this  average  duration 
and  character  there  are  great  natural  deviations, 
the  disease  being  sometimes  so  slight,  as  to 
attract  the  notice  of  none  but  medical  eyes, 
and  sometimes  so  malignant,  that  treatment  is 
admitted  to  be  hopeless.  The  modes  of  treat- 
ment, which  have  had  most  testimony  in  their 
favor,  are  various,  and  opposite.  By  Dr.  Fother- 
gill,  stimulants  were  relied  on  ;  by  Dr.  Currie, 
cold  water  ;  by  Dr.  South  wood  Smith,  and 
others,  blood  letting.  But  it  is  not  satisfactorily 
shown,  that  either  of  these  modes  of  practice 


12  SELF-LIMITED    DISEASES. 

'has  been  particularly  successful ;  for  where  the 
writers  have  furnished  us  anything  like  definite, 
•or  numerical  results,  it  does  not  appear  that  the 
mortality  was  less  in  their  hands  than  it  is 
among  those  who  pursue  a  more  expectant 
practice.  The  post  mortuary  appearances,  which 
in  many  diseases  furnish  useful  lessons  for  prac- 
tice, are  in  scarlet  fever  extremely  various  and 
uncertain ;  and  sometimes  no  morbid  changes, 
sufficient  to  account  for  death,  can  be  discovered 
in  any  of  the  vital  organs,  or  great  cavities. 
{Note  E.] 

Small  Pox  is  another  example  of  the  class  of 
affections  under  consideration,  its  approach  and 
disappearance  being  irrespective  of  medical 
^practice.  It  may,  at  first  view,  appear,  that 
inoculation  has  placed  artificial  limits  on  this 
•disease.  But  it  must  be  recollected,  that  inocu- 
lated small  pox  is  itself  only  a  milder  variety 
of  the  same  disease,  having  its  own  customary 
limits  of  extent  and  duration,  which  are  fixed, 
quite  as  much  as  those  of  the  distinct  and  con- 
-fluent  forms  of  the  natural  disease. 

Erysipelas  is  an  eruptive  fever,  having  strong 
analogies  with  those  which  have  been  detailed. 


SELF-LIMITED     DISEASES.  13 

It  is  not  certain,  that  art  can  very  materially 
affect  either  the  duration  or  the  extent  of  this 
malady.  If  a  physician  is  called  to  a  case  of 
erysipelas,  which  is  beginning  to  be  developed 
upon  a  part  of  the  face  ;  and  if  he  is  asked, 
whether  the  disease  will  extend  to  the  crown,  or 
the  neck,  or  to  the  right  ear,  or  the  left,  —  he 
cannot  tell.  And  if  he  is  asked  to  prevent  it 
from  visiting  either  of  these  places,  I  know  of 
no  satisfactory  evidence  that  he  can  do  it. 
Erysipelas,  however,  in  a  great  number  of  sim- 
ple, or  exanthematous  cases,  in  subjects  previ- 
ously healthy,  gets  well  without  any  treatment  > 
and  in  a  great  number  of  deep-seated  and 
phlegmonous  cases,  as  well  as  those  in  which 
vital  organs  are  affected,  it  proves  fatal  under 
the  most  approved  methods  of  medical  and 
surgical  practice.  It  is  true,  that  patients  have 
recovered,  under  punctures,  incisions,  and  cau- 
tery. It  is  also  true,  that  they  have  died  under 
the  same  operations,  so  that  it  may  be  submit- 
ted as  a  doubtful  point,  whether  we  yet  possess 
adequate  evidence,  that  erysipelas  is  not  also  a 
self-limited  disease. 

It  is  a  question  of  great  interest  to  the  medi- 


14  SELF-LIMITED    DISEASES. 

cal  profession,  to  determine  whether  typhoid 
fever  is  a  disease  susceptible  of  control  from 
medical  means.  On  this  subject  no  one  now 
doubts,  that  if  the  disease  is  once  fairly  estab- 
lished in  the  system,  it  cannot  be  eradicated  by 
art,  but  must  complete  a  certain  natural  course, 
before  convalescence  can  take  place.  But  a 
question  still  exists,  whether  this  disease  is 
capable  of  being  jugulated,  or  broken  up,  at  its 
outset,  by  the  early  application  of  remedies. 

It  must  be  allowed,  that  attacks  of  disease 
resembling  those  of  typhoid,  sometimes  speedily 
disappear  during  the  use  of  remedies ;  but  it  is 
by  no  means  certain  that  such  cases  are  actually 
cases  of  typhoid.  The  diagnosis  of  this  disease, 
during  the  first  day  or  two,  is  extremely  diffi- 
cult, its  character  being  similated  by  different 
febrile  and  inflammatory  affections  ;  so  that  if  a 
patient,  under  the  use  of  remedies,  succeeds  in 
avoiding  protracted  disease,  we  are  not  justified 
in  saying,  that  the  disease  he  has  escaped  was 
typhoid  or  typhous  fever.  Andral,  whose  ex- 
periments on  the  different  modes  of  treatment  in 
continued  fever,  are  very  extensive,  has  stated, 
that  in  a  number  of  cases,  observed  by  him,  in 


SELF-LIMITED    DISEASES.  15 

which  the  fever  was  sufficiently  intense,  the  dis- 
ease ceased  in  twenty-four  or  forty-eight  hours, 
without  any  treatment,  except  that  of  rest  and 
a  regulated  diet.* 

Moreover,  in  weighing  the  influence  of  treat- 
ment, it  ought  to  be  recollected,  that  during  the 
existence  of  any  prevailing  epidemic,  mild  cases, 
partaking  of  a  similar  character  to  that  of  the 
reigning  disease,  continually  appear  among  the 
less  susceptible  part  of  the  community.  Thus 
cholera  is  attended  by  diarrhosa  or  cholerine, 
influenza  by  mild  catarrh,  small  pox  by  varioloid, 
scarlet  fever  by  slight  sore  throats  or  ephemeral 
eruptions,  &c.  Now,  although  these  cases  are 
in  reality  modified  examples  of  the  grave  dis- 
eases which  they  accompany,  yet  I  believe  that 
no  well-informed  physician  will  attribute  the 
mildness  or  shortness  of  their  character  to  his 
own  particular  practice. 

On  the  other  hand,  it  is  certain  that  cases  of 
real  typhoid  do  often  come  under  active  treat- 
ment at  an  early  stage,  without  being  broken 
up,  or  disarmed  of  their  appropriate  conse- 

*  Clinique  III.  619. 


16  SELF-LIMITED    DISEASES. 

quences.  This  particularly  happens,  when  the 
disease  is  endemic  in  families,  so  that  succes- 
sive cases  begin,  as  it  were,  under  the  eye  of  the 
attending  physician,  who  has  every  possible 
inducement  to  detect  and  prevent  them,  if  he 
can.  In  such  families,  indeed,  it  will  sometimes 
happen,  that  febrile  attacks  of  different  kinds, 
consequent  upon  fatigue  and  anxiety,  and  per- 
haps partaking  of  the  typhoid  character,  will 
take  place  among  the  friends  and  attendants  of 
the  sick ;  and  these  may  disappear  speedily, 
under  rest  and  evacuations.  But  that  grave 
and  specific  typhoid  fever  will  thus  disappear,  is 
a  point  of  which  we  as  yet  want  proof.  That 
it  sometimes  fails  to  disappear,  we  have  abun- 
dant proof. 

Typhoid  fever  has,  in  many  respects,  a  mark- 
ed affinity  with  the  class  of  eruptive  fevers, 
which  are  supposed  to  depend  on  a  specific 
morbid  poison,  and  which  no  one  pretends  to 
intercept,  after  the  body  has  become  infected 
with  them.  Scarlet  fever  and  measles,  for  ex- 
ample, when  once  established,  require  a  certain 
number  of  days  to  finish  their  course ;  so  also 
does  the  typhoid.  Scarlet  fever  and  measles 


SELF-LIMITED    DISEASES.  17 

can,  in  most  cases,  be  had  but  once  during  life ; 
but  to  this  general  rule  there  are  exceptions. 
The  same  is  precisely  true  in  regard  to  typhoid. 
The  contagiousness  of  scarlet  fever  is  a  point 
of  dispute  among  physicians ;  and  so  is  that 
of  typhoid.  Scarlet  fever  is  attended  by  an 
eruption  on  the  skin.  Typhoid  fever  also  has 
for  one  of  its  most  constant  symptoms  a  red, 
lenticular  eruption,  consisting  of  a  few  scatter- 
ed rose-colored  pimples,  appearing  chiefly  on 
the  trunk,  from  about  the  sixth  to  the  nineteenth 
day  of  the  disease.  There  also  occurs,  in  most 
subjects,  a  minute,  vesicular  eruption  of  suda- 
mina,  about  the  neck  and  elsewhere.  In  scarlet 
fever,  moreover,  certain  portions  of  the  mucous 
membrane  undergo  morbid  alterations,  particu- 
larly on  the  tonsils,  and  other  parts  of  the 
fauces,  and  these  frequently  degenerate  into 
ulcers,  affecting  the  subjacent  textures.  In  like 
manner,  in  typhoid  fever,  the  mucous  membrane 
of  the  glandular  patches  in  the  small  intestines, 
which  have  been  named  after  the  anatomist 
Peyer,  undergo  morbid  changes',  and  these 
changes  are  followed  by  ulcerations,  and  some- 
times perforations  of  the  intestine.  This  fact, 
2 


18  SELF-LIMITED    DISEASES. 

established  by  the  researches  of  Louis  and  other 
pathologists  in  Paris,  has  been  abundantly  con- 
firmed by  post  mortem  examinations  made  in 
this  country  during  the  last  few  years.*  If  it 
be  objected  to  the  proposed  classification  of  this 
fever,  that  the  taches  are  sometimes  few  in 
number,  or  wholly  absent :  it  is  equally  true, 
that  the  pustules  of  inoculated  small  pox  are 
likewise  often  very  few,  or  absent ;  and  that  the 
eruption  of  scarlatina  sometimes  wholly  fails  to 
appear.  The  sore  throat  also  in  the  latter  dis- 
ease is  wanting,  quite  as  often,  to  say  the  least, 
as  the  morbid  affection  of  Peyer's  glands. 

Before  quitting  the  subject,  I  beg  leave  to 
introduce  the  opinion  of  one  or  two  medical 
writers,  in  regard  to  the  possibility  of  interrupt- 
ing or  breaking  up  this  disease  by  means  of  art. 
M.  Louis,  of  whose  researches  in  regard  to 
typhoid  fever,  it  is  but  small  praise  to  say,  that 
they  are  more  exact  and  comprehensive  than 
those  of  any  living  writer,  is  of  opinion  that  the 
disease  cannot  be  thus  intercepted.  '  Experi- 
ence,' says  he,  « has  shown,  that  a  well  marked 
typhoid  affection  is  not  capable  of  being  broken 
*  1835. 


SELF-LIMITED    DISEASES.  19 

up.'  *  To  this  testimony  of  one  of  the  most 
eminent  teachers  in  the  French  metropolis,  it 
may  not  be  amiss  to  add  that  of  an  American 
physician,  whose  opportunities  for  observing  the 
disease  in  different  parts  of  New  England  were 
extensive,  and  whose  Essay  on  Typhus  Fever 
well  merits  an  attentive  perusal.  The  late  Dr. 
Nathan  Smith,  in  the  course  of  some  remarks 
on  the  possibility  of  interrupting  this  disease  at 
commencement,  observes :  '  During  the  whole  of 
my  practice  I  have  never  been  satisfied  that  I 
have  cut  short  a  single  case  of  typhus,  that  I 
knew  to  be  such.'  f 

*  « L'experience  ayant  montre,  que  Taffection  typhoide  bien 
caracterisee,  n'est  pas  susceptible  d'etre  jugulee,  ce  qui  n'est 
guere  moins  vrai,  d'ailleurs,  suivant  toutes  les  apparences,  de 
la  peripneumonie  et  des  autres  maladies  inflammatoires.'  — 
Louis,  Gastro-enterite.  II.  512. 

Andral  says,  in  regard  to  the  different  modes  of  treatment  in 
typhus,  '  Quelles  que  soient  les  methodes  employees,  il  est  un 
certain  nombre  de  cas  ou,  sans  que  ces  methodes  y  prennent  part, 
la  nature  conduit  la  maladie  k  une  terminaison  heureuse  ou 
funeste.  —  Clinique  III.  616,  617. 

t  At  the  time  of  the  publication  alluded  to,  the  distinction  be- 
tween typhus  and  typhoid  fevers  had  not  been  well  made  out. 
The  distinction  is  good,  though  writers  of  authority  differ  on  the 
subject. 


20  SELF-LIMITED    DISEASES. 

Having  said  thus  much,  I  leave  the  subject  of 
the  tractability  of  typhus  and  typhoid  fever  to 
the  light  of  future  investigation.  It  is  but 
justice  to  state,  that  numerous  and  highly 
respectable  authorities  are  declared  in  favor  of 
the  efficacy  of  art  in  shortening  and  mitigating 
these  diseases  ;  and  it  will  be  a  source  of 
gratification  to  the  friends  of  humanity  and 
science,  should  it  ultimately  be  settled,  that 
the  active  treatment  now  usually  pursued  at 
the  commencement  of  cases,  is  instrumental 
in  lessening  their  duration,  severity,  or  dan- 
ger. 

Among  the  morbid  affections  which  have 
now  been  enumerated,  may  be  found  sufficient 
examples  of  continued  diseases,  which  receive 
limits  from  their  own  nature,  and  not  from  the 
interference  of  art.  Whether  the  number  of 
these  diseases  may  not  be  augmented  by  ad- 
ditions from  among  other  fevers,  and  acute 
inflammations,  I  am  not  prepared  to  decide.  It 
is  difficult,  however,  to  withhold  the  belief,  that 
a  more  extended  inquiry  must  probably  serve  to 
multiply,  rather  than  diminish,  the  number  of 


SELF-LIMITED    DISEASES.  21 

maladies  to  which  this  character  will  be  found 
appropriate.* 

We  come  next  to  a  second  order  of  self- 
limited  diseases,  of  which  the  term  paroxysmal 
is  sufficiently  descriptive.  This  term  applies  to 
certain  morbid  affections,  which  recur  in  fits  or 
paroxysms,  leaving  the  patient  comparatively 
well  in  the  intervals,  at  the  same  time  that  the 
paroxysms  themselves  can  neither  be  foreseen, 
prevented,  nor,  as  far  as  we  know,  materially 
abridged  in  their  duration.  At  the  head  of  this 
subdivision  stands  Epilepsy,  a  disease  which 
has  long  been  eminent  as  an  opprobrium  of 
medicine,  and  for  which,  it  is  believed,  the 
healing  art  has  not  yet  devised  a  cure.  The 
first  attacks  of  epilepsy,  especially  while  there  is 
any  doubt  as  to  the  nature  of  the  malady,  are 
usually  made  the  subjects  of  active  and  various 
treatment.  But  after  the  recurring  paroxysms 
have  established  the  character  of  the  disease,  if 

*  There  is  not  room  here  to  discuss  the  question  whether 
Pneumonia  and  other  acute  inflammations  fall  under  the  category 
of  self-limitation.  Blood-letting,  in  proper  cases,  lessens  the 
severity  and  danger  of  these  diseases.  But  it  is  not  apparent 
that  it  greatly  abridges  their  duration.  Dysentery  may  be 
accounted  a  self-limited  disease. 


22  SELF-LIMITED    DISEASES. 

active  medical  practice  is  persevered  in,  it  is 
rather  to  satisfy  the  anxiety  of  friends,  than  the 
judgment  of  the  practitioner. 

Angina  pectoris,  appropriately  called  by  Dr. 
Good,  Sternalgia,  is  a  paroxysmal  disease,  which 
in  many  cases  controls  its  own  movements. 
The  anatomical  character  of  this  disease  is  not 
uniform,  and  I  may  add,  the  same  is  true  of  its 
medical  treatment.  And  in  this  place  it  may 
be  proper  to  state,  that  various  incurable  lesions 
of  the  heart,  lungs,  brain,  and  other  viscera, 
do  not  apparently  destroy  life  by  a  regular, 
undeviating  march;  but  that  as  far  as  their 
outward  phenomena  afford  evidence,  they  seem 
to  proceed  by  alternate  fits  and  pauses,  under- 
going, in  their  progress,  all  states,  except  that 
of  retrogradation.  This  is  apparently  true 
in  regard  to  tubercle,  carcinoma,  ossification, 
hypertrophy,  and  some  other  morbid  alterations. 
It  is  also  even  true  in  regard  to  old  age  itself. 

Thirty  years  ago,  we  might  have  added  gout 
to  the  opprobrious  list  under  consideration.  But 
as  we  may  now  be  said  to  possess  the  means  of 
shortening  the  paroxysms,  by  the  use  of  certain 
acrid  narcotics ;  and  as  an  abstemious  life  goes 


SELF-LIMITED    DISEASES.  23 

far  towards  lessening  the  frequency  and  violence 
of  the  recurrence,  we  may  be  justified  in  with- 
drawing gout  from  the  place  it  would  otherwise 
occupy.  [Note  F.] 

The  diseases  of  mania  and  melancholy, 
asthma,  when  it  depends  on  emphysema  of  the 
lungs,  gravel  in  the  kidneys,  and  the  symptoms 
produced  by  ascarides  in  the  rectum,  [Note  G], 
furnish  other  examples  of  maladies,  which 
manifest  themselves  in  unforeseen  paroxysms. 
Cases,  which  bear  the  names  of  all  the  above 
diseases,  are  undoubtedly  relieved,  and  some- 
times even  removed  by  medicine;  but  it  is 
equally  true,  that  other  cases  are  wholly  in- 
tractable, both  as  to  their  recurrence,  their 
.duration,  and  their  susceptibility  of  much 
change  from  medical  treatment.  And  it  will 
come  to  the  recollection  of  many  practitioners, 
that  they  have,  in  the  course  of  their  lives, 
believed  themselves  to  have  cured  these  dis- 
eases, when  in  fact  they  have  only  witnessed 
the  spontaneous  subsidence  of  a  paroxysm. 

The  last  subdivision  of  our  subject  includes 
what  may  be  called  metastatic  diseases.  By 
this  term  I  wish  to  express  certain  morbid 


24  SELF-LIMITED    DISEASES. 

affections,  which  pass  by  metastasis  from  one 
part  of  the  body  to  another,  for  the  most  part 
independently  of  artificial  influence.  Of  this 
kind  are  certain  cutaneous  affections,  more  espe- 
cially some  which  are  chronic  and  hereditary. 
Many  persons  pass  a  considerable  portion  of 
their  lives  in  alternate  annoyance  from  a 
disease  of  the  skin,  and  from  its  vicarious 
substitute  in  some  internal  organ.  Others 
again  are  afflicted  with  hemorrhagic,  or  puru- 
lent discharges,  which  at  times  disappear,  only 
to  be  succeeded  by  equally  troublesome  affec- 
tions in  a  different  part.  Gonorrhoea  cannot 
be  prevented  from  occasional  metastasis  of 
inflammation,  and  mumps  are  sometimes  found 
to  undergo  the  same  transition.  But  perhaps 
the  most  remarkable  example  of  a  metastatic 
disease  is  found  in  acute  rheumatism.  This 
morbid  affection  often  begins  to  discover  itself 
in  a  limited  and  comparatively  unimportant 
part  of  the  system.  From  thence,  in  grave 
cases,  it  travels  by  successive  •migrations  from 
joint  to  joint,  and  from  limb  to  limb,  till  it  has 
visited  nearly  all  the  great  articulations  of  the 
body.  It  also  attacks  the  organs  of  sense,  and 


SELF-LIMITED    DISEASES.  25 

the  viscera  which  are  essential  to  life.  During 
the  course  of  these  migrations,  the  attending 
physician  cannot  foretell  at  any  given  stage, 
what  part  will  be  next  invaded  by  the  disease, 
neither  can  he  protect  any  part  from  being  thus 
invaded ;  nor  can  he  control  the  period,  during 
which  the  disease  will  reside  in  any  particular 
part  previously  to  its  next  metastasis.  Never- 
theless acute  rheumatism  is  susceptible  of  great 
palliation  though  of  little  abridgment,  and 
after  having  run  out  its  career,  terminates  in 
spontaneous  recovery ;  not,  however,  in  some 
cases,  until  it  has  laid  the  foundation  of  serious 
organic  derangements,  especially  of  the  heart. 

I  forbear  to  dilate  on  the  structural  lesions  of 
different  organs,  many  of  which  can  only  be 
cured  by  the  extirpation  of  the  part  in  which 
they  reside,  thus  sacrificing  the  integrity  of  the 
body  to  the  preservation  of  life  ;  and  in  which 
extirpation  cannot  avail,  when  the  seat  of  the 
disease  is  in  a  vital  part.  I  also  pass  over  the 
pestilential  epidemics  of  plague,  yellow  fever, 
malignant  dysentery  and  cholera  ;  diseases 
about  which  the  medical  profession  have  great 
differences  of  opinion,  and  of  which  thousands 


26  SELF-LIMITED    DISEASES. 

die  annually,  though  hundreds  of  volumes  have 
been  written  for  their  preservation.     [Note  H.] 

It  may  perhaps  appear  that  the  views  which 
have  now  been  taken  of  the  power  of  medicine, 
in  so  large  a  class  of  diseases,  are  gloomy  and 
discouraging,  and  that  an  unworthy  tribute  is 
paid  to  the  labors  of  those  physicians,  who  have 
patiently  studied,  and  ardently  acted,  for  the 
benefit  of  humanity.  Such  views,  however,  are 
far  from  being  the  object  of  the  present  dis- 
course. Were  it  permitted  by  the  compass  of 
the  subject  under  consideration,  it  would  be  a 
very  grateful  task  to  enumerate  those  maladies 
of  the  human  frame,  over  which  we  have  reason 
to  believe  that  medicine  has  obtained  decisive 
influence.  To  a  medical  audience,  it  is  un- 
necessary to  recall  the  instances  of  pain  reliev- 
ed, spasms  controlled,  inflammations  checked, 
[Note  I],  and  diseased  associations  broken  up, 
under  limitable  diseases,  by  the  agency  of  the 
healing  art.  Were  there  no  other  trophy  for  the 
medical  profession  to  boast,  it  is  sufficient  to 
know,  that  the  diseases  of  small  pox  and  syphi- 
lis alone  would  have  entailed  misery  and  exter- 
mination on  a  large  portion  of  our  species,  had 


SELF-LIMITED   DISEASES.  27 

not  medical  science  discovered  the  prevention 
of  the  one,  and  the  successful  management  of 
the  other. 

But  that  the  usefulness  of  our  profession  may 
extend,  our  knowledge  must  go  on  to  increase  ; 
and  the  foundation  of  all  knowledge  is  truth. 
For  truth  then  we  must  earnestly  seek,  even 
when  its  developments  do  not  flatter  our  pro- 
fessional pride,  nor  attest  the  infallibility  of  our 
art.  To  discover  truth  in  science,  is  often  ex- 
tremely difficult ;  in  no  science  is  it  more  diffi- 
cult than  in  medicine.  Independently  of  the 
common  defects  of  medical  evidence,  our  self- 
interest,  our  self-esteem,  and  sometimes  even 
our  feelings  of  humanity,  may  be  arrayed 
against  the  truth.  It  is  difficult  to  view  the 
operations  of  nature,  divested  of  the  interfer- 
ences of  art,  so  much  do  our  habits  and  partial- 
ities incline  us  to  neglect  the  former,  and  to 
exaggerate  the  importance  of  the  latter.  The 
mass  of  medical  testimony  is  always  on  the  side 
of  art.  Medical  books  are  prompt  to  point  out 
the  cure  of  diseases.  Medical  journals  are  filled 
with  the  crude  productions  of  aspirants  to  the 
cure  of  diseases.  Medical  schools  find  it  incum- 


28  SELF-LIMITED    DISEASES. 

bent  on  them  to  teach  the  cure  of  diseases. 
The  young  student  goes  forth  into  the  world, 
believing  that  if  he  does  not  cure  diseases,  it  is 
his  own  fault.  Yet  when  a  score  or  two  of 
years  have  passed  over  his  head,  he  will  come 
at  length  to  the  conviction,  that  some  diseases 
are  controlled  by  nature  alone.  He  will  often 
pause  at  the  end  of  a  long  and  anxious  attend- 
ance, and  ask  himself,  how  far  the  result  of  the 
case  is  different  from  what  it  would  have  been 
under  less  officious  treatment,  than  that  which 
he  has  pursued  ;  how  many  in  the  accumulated 
array  of  remedies,  which  have  supplanted  each 
other  in  the  patient's  chamber,  have  actually 
been  instrumental  in  doing  him  any  good.  He 
will  also  ask  himself  whether,  in  the  course  of 
his  life,  he  has  not  had  occasion  to  change  his 
opinion,  perhaps  more  than  once,  in  regard  to 
the  management  of  the  disease  in  question,  and 
whether  he  does  not,  even  now,  feel  the  want  of 
additional  light. 

Medicine  has  been  rightly  called  a  conjectural 
art,  because  in  many  of  its  deductions,  and  es- 
pecially in  those  which  relate  to  the  cure  of 
diseases,  positive  evidence  is  denied  to  us.  We 


SELF-LIMITED    DISEASES.  29 

are  seldom  justified  in  concluding  that  our 
remedies  have  promoted  the  cure  of  a  disease, 
until  we  know  that  cases  exactly  similar  in 
time,  place,  and  circumstances,  have  failed  to  do 
equally  well  under  the  omission  of  those  reme- 
dies ;  and  such  cases,  moreover,  must  exist  in 
sufficient  numbers  to  justify  the  admission  of  a 
general  law,  on  their  basis.  Nothing  can  be 
more  illogical,  than  to  draw  our  general  conclu- 
sions, as  we  are  sometimes  too  apt  to  dp,  from 
the  results  of  insulated  and  remarkable  cases; 
for  such  cases  may  be  found  in  support  of  any 
extravagance  in  medicine ;  and  if  there  is  any 
point  in  which  the  vulgar  differ  from  the  judi- 
cious part  of  the  profession,  it  is  in  drawing 
premature  and  sweeping  conclusions,  from 
scanty  premises  of  this  kind.  Moreover,  it  is 
in  many  cases  not  less  illogical  to  attribute  the 
removal  of  diseases,  or  even  of  their  troublesome 
symptoms,  to  the  means  which  have  been  most 
recently  employed.  It  is  a  common  error  to 
infer  that  things  which  are  consecutive  in  the 
order  of  time,  have  necessarily  the  relation  to 
cause  and  effect.  It  often  happens  that  the  last 
remedy  used,  bears  off  the  credit  of  having  re- 


30  SELF-LIMITED    DISEASES. 

moved  an  obstruction,  or  cured  a  disease,  whereas 
in  fact  the  result  may  have  been  owing  to  the 
first  remedy  employed,  or  to  the  joint  effect  of 
all  the  remedies,  or  to  the  act  of  nature,  unin- 
fluenced by  any  of  the  remedies.  We  see 
this  remarkably  exemplified  in  recoveries  from 
amenorrhoea,  and  from  various  irregularities  of 
the  alimentary  canal. 

An  inherent  difficulty,  which  every  medical 
man  finds  to  stand  in  the  way  of  an. unbiased 
and  satisfactory  judgment,  is  the  heavy  respon- 
sibility which  rests  upon  the  issue  of  his  cases. 
When  a  friend,  or  valuable  patient,  is  commit- 
ted to  our  charge,  we  cannot  stand  by,  as  curi- 
ous spectators,  to  study  the  natural  history  of 
his  disease.  We  feel  that  we  are  called  on  to 
attempt  his  rescue  by  vigorous  means,  so  that 
at  least  the  fault  of  omission  shall  not  lie  upon 
our  charge.  We  proceed  to  put  in  practice 
those  measures,  which  on  the  whole  have  ap- 
peared to  us  to  do  most  good  ;  and  if  these  fail 
us,  we  resort  to  other  measures,  which  we  have 
read  of,  or  heard  of.  And  at  the  end  of  our 
attendance  we  may  be  left  in  uncertainty, 
whether  the  duration  of  sickness  has  been 


SELF-LIMITED    DISEASES.  31 

shortened,  pr  lengthened,  by  our  practice,  and 
whether  the  patient  is  really  indebted  to  us  for 
good  or  evil.  In  the  study  of  experimental 
philosophy,  we  rarely  admit  a  conclusion  to  be 
true,  until  its  opposite  has  been  proved  to  be 
untrue.  But  in  medicine  we  are  often  obliged, 
to  be  content  to  accept  as  evidence  the  results 
of  cases,  which  have  been  finished  under  treat- 
ment, because  we  have  not  the  opportunity  to 
know  how  far  these  results  would  have  been 
different,  had  the  cases  been  left  to  themselves. 
And  it  too  frequently  happens,  that  medical 
books  do  not  relieve  our  difficulties  on  this  score, 
for  a  great  deal  of  our  practical  literature  con- 
sists in  reports  of  interesting,  extraordinary,  and 
successful  results,  published  by  men  who  have 
a  doctrine  to  establish,  or  a  reputation  to  build. 
'  Few  authors,'  says  Andral,  '  have  published  all 
the  cases  they  have  observed,  and  the  greater 
part  have  only  taken  the  trouble  to  present  to 
us  those  facts  which  favor  their  own  views.'  * 
A  prevailing  error  among  writers  on  therapeu- 

*  Bien  peu  d'auteurs  ont  public  tous  les  cas  qu'ils  ont  ob- 
serves, et  la  plupart  ne  se  sont  empresses  de  nous  transmettre 
que  les  faits  que  caressaient  leurs  idees.  —  Clinique  III.  618. 


32  SELF-LIMITED    DISEASES. 


tics,  proceeds  from  their  professional,  or  personal 
reluctance  to  admit  that  the  healing  art,  as 
practised  by  them,  is  not,  or  may  not  be,  all 
sufficient,  in  all  cases ;  so  that  on  this  subject 
they  suffer  themselves,  as  well  as  their  readers, 
to  be  deceived.  Hence  we  have  no  disease, 
however  intractable  or  fatal,  for  which  the  press 
has  not  poured  forth  its  asserted  remedies. 
Even  of  late,  we  have  seen  unfailing  cures  of 
cholera  successively  announced  in  almost  every 
city,  in  which  that  pestilence  unchecked  has 
completed  its  work  of  devastation  ! 

It  is  only  when,  in  connection  with  these  flat- 
tering exhibitions,  we  have  a  full  and  faithful 
report  of  the  failures  of  medical  practice,  in 
similar,  and  in  common  cases,  setting  forth  not 
only  the  truth,  but  the  whole  truth,  that  we 
have  a  basis  sufficiently  broad  to  erect  a  super- 
structure in  therapeutics,  on  which  dependence 
may  be  placed.  Such,  it  must  give  the  friends 
of  science  gratification  to  observe,  is  a  part  of 
the  rigid  method  which  characterizes  the  best 
examples  of  the  modern  French  school ;  and 
such,  it  is  not  difficult  to  foresee,  must  ultimate- 
ly be  the  only  species  of  evidence  on  this  sub- 


SELF-LIMITED    DISEASES.  33 

ject,  to  which  the  medical  profession  will  pay 
deference. 

It  appears  to  me  to  be  one  of  the  most  im- 
portant desiderata  in  practical  medicine,  to 
ascertain,  in  regard  to  each  doubtful  disease, 
how  far  its  cases  are  really  self-limited,  and  how 
far  they  are  controllable  by  any  treatment. 
This  question  can  be  satisfactorily  settled  only 
by  instituting,  in  a  large  number  of  cases, 
which  are  well  identified  and  nearly  similar,  a 
fair  experimental  comparison  of  the  different 
active  and  expectant  modes  of  practice,  with 
their  varieties  in  regard  to  time,  order,  and 
degree.  This  experiment  is  vast,  considering 
the  number  of  combinations  which  it  must  in- 
volve ;  and  even  much  more  extensive  than  a 
corresponding  series  of  pathological  observa- 
tions ;  yet  every  honest  and  intelligent  observer 
may  contribute  to  it  his  mite.  Opportunities 
for  such  observations,  and  especially  for  mono- 
graphs of  diseases,  are  found  in  the  practice  of 
most  physicians,  yet  hospitals  and  other  public 
charities  afford  the  most  appropriate  field  for 
instituting  them  upon  a  large  scale.  The  ag- 
gregate of  results,  successful  and  unsuccessful, 
3 


34  SELF-LIMITED    DISEASES. 

circumstantially  and  impartially  reported  by 
competent  observers,  will  give  us  a  near  approx- 
imation to  truth,  in  regard  to  the  diseases  of  the 
time  and  place,  in  which  the  experiments  are 
instituted.  The  numerical  method  employed  by 
Louis  in  his  extensive  pathological  researches, 
and  now  adopted  by  his  most  distinguished 
contemporaries  in  France,  affords  the  means  of 
as  near  an  approach  to  certainty  on  this  head, 
as  the  subject  itself  admits.  And  I  may  add, 
that  no  previous  medical  inquirer  has  apparently 
submitted  to  the  profession  any  species  of 
evidence  so  broad  in  its  foundations,  and  so 
convincing  in  its  results,  as  that  which  charac- 
terizes the  great  works  of  this  author  on 
Phthisis  and  Typhoid  fever. 

In  regard  to  acknowledged  self-limited  dis- 
eases, the  question  will  naturally  arise,  whether 
the  practitioner  is  called  on  to  do  nothing  for 
the  benefit  of  his  patient ;  whether  he  shall  fold 
his  hands,  and  look  passively  on  the  progress  of 
a  disease,  which  he  cannot  interrupt.  To  this 
I  would  answer, — by  no  means.  The  opportu- 
nities of  doing  good  may  be  as  great  in  these 
diseases  as  in  any  others ;  for,  in  treating  every 


SELF-LIMITED    DISEASES.  35 

disease,  there  is  a  right  method,  and  a  wrong. 
In  the  first  place,  we  may  save  the  patient  from 
much  harm,  not  only  by  forbearing  ourselves  to 
afflict  him  with  unnecessary  practice,  but  also 
by  preventing  the  ill-judged  activity  of  others. 
For  the  same  reason  that  we  would  not  suffer 
him  to  be  shaken  in  his  bed,  when  rest  was 
considered  necessary  to  him,  we  should  not 
allow  him  to  be  tormented  with  useless  and 
annoying  applications,  in  a  disease  of  settled 
destiny*  It  should  be  remembered  that  all 
cases  are  susceptible  of  errors  of  commission,  as 
well  as  of  omission,  and  that  by  an  excessive 
application  of  the  means  of  art,  we  may  frus- 
trate the  intentions  of  nature,  when  they  are 
salutary,  or  embitter  the  approach  of  death  when 
it  is  inevitable.  What  practitioner,  I  would 
ask,  ever  rendered  a  greater  service  to  mankind, 
than  Ambrose  Pare,  and  his  subsequent  coadju- 
tors, who  introduced  into  modem  surgery  the 
art  of  healing  by  the  first  intention?  These 
men  with  vast  difficulty  succeeded  in  convinc- 
ing the  profession,  that  instead  of  the  old  meth- 
od of  treating  incised  wounds  by  keeping  them 


36  SELF-LIMITED    DISEASES. 

open  with  forcible  and  painful  applications,  it 
was  better  simply  to  place  the  parts  securely  in 
their  natural  situation,  and  then  to  let  them 
alone.  In  the  second  place,  we  may  do  much 
good  by  a  palliative  and  preventive  course,  by 
alleviating  pain,  procuring  sleep,  guarding  the 
diet,  regulating  the  alimentary  canal,  —  in  fine, 
by  obviating  such  sufferings  as  admit  of  miti- 
gation, and  preventing  or  removing  the  causes 
of  others,  which  are  incidental,  but  not  neces- 
sary, to  the  state  of  disease.  In  doing  this,  we 
must  distinguish  between  the  disease  itself,  and 
the  accidents  of  the  disease,  for  the  latter  often 
admit  of  relief,  when  the  former  do  not.  We 
should  also  inquire  whether  the  original  cause 
of  the  disease,  or  any  accessory  cause,  is  still 
operating,  and  if  so,  whether  it  can  in  any 
measure  be  prevented  or  removed ;  as,  for  ex- 
ample, when  it  exists  in  the  habits  of  life  of  the 
patient,  in  the  local  atmosphere,  or  in  the  pre- 
sence of  any  other  deleterious  agent.  [Note  K.J 
Lastly,  by  a  just  prognosis,  founded  on  a  correct 
view  of  the  case,  we  may  sustain  the  patient 
and  his  friends  during  the  inevitable  course  of 
the  disease ;  and  may  save  them  from  the  pangs 


SELF-LIMITED    DISEASES.  37 

of  disappointed  hope  on  the  one  side,  or  of  un- 
necessary despondency  on  the  other. 

It  will  be  seen  that,  in  the  foregoing  remarks, 
a  low  estimate  has  been  placed  on  the  resources 
of  art,  when  compared  with  those  of  nature. 
But  I  may  be  excused  for  doing  this  in  the 
presence  of  an  audience  of  educated  men,  and 
the  members  of  a  society,  whose  motto  is  Natu- 
rd  duce.  The  longer  and  the  more  philosophi- 
cally we  contemplate  this  subject,  the  more 
obvious  it  will  appear,  that  the  physician  is  but 
the  minister  and  servant  of  nature  ;  that  in  cases 
like  those  which  have  been  engaging  our  con- 
sideration, we  can  do  little  more  than  follow  in 
the  train  of  disease,  and  endeavor  to  aid  nature 
in  her  salutary  intentions,  or  to  remove  obstacles 
out  of  her  path.  How  little,  indeed,  could  we 
accomplish  without  her  aid!  —  It  has  been 
wisely  observed  by  Sir  Gilbert  Blane,  that  'the 
benefit  derivable  to  mankind  at  large,  from 
artificial  remedies,  is  so  limited,  that  if  a  spon- 
taneous principle  of  restoration  had  not  existed, 
the  human  species  would  long  ago  have  been 
extinct.'  * 

*  Medical  Logic,  p.  49. 


38  SELF-LIMITED    DISEASES. 

The  importance  and  usefulness  of  the  medi- 
cal profession,  instead  of  being  diminished,  will 
always  be  elevated,  exactly  in  proportion  as  it 
understands  itself,  weighs  justly  its  own  powers, 
and  professes  simply  what  it  can  accomplish. 
It  is  no  derogation  from  the  importance  of  our 
art,  that  we  cannot  always  control  the  events  of 
life  and  death,  or  even  of  health  and  sickness. 
The  incompetency  which  we  feel  in  this  respect, 
is  shared  by  almost  every  man  upon  whom  the 
great  responsibilities  of  society  are  devolved. 
The  statesman  cannot  control  the  destinies  of 
nations,  nor  the  military  commander  the  event 
of  battles.  The  most  eloquent  pleader  may  fail 
to  convince  the  judgment  of  his  hearers,  and  the 
most  skilful  pilot  may  not  be  able  to  weather 
the  storm.  Yet  it  is  not  the  less  necessary,  that 
responsible  men  should  study  deeply  and  under- 
standingly  the  science  of  their  respective  voca- 
tions. It  is  not  the  less  important,  for  the  sake 
of  those  whose  safety  is,  and  always  will  be, 
committed  to  their  charge,  that  they  should  look 
with  unbiased  judgment  upon  the  necessary 
results  of  inevitable  causes.  And  while  an 
earnest  and  inquiring  solicitude  should  always 


SELF-LIMITED    DISEASES.  39 

be  kept  alive,  in  regard  to  the  improvement  of 
professional  knowledge,  it  should  never  be  for- 
gotfen,  that  knowledge  has  for  its  only  just  and 
lasting  foundation,  a  rigid,  impartial,  and  inflex- 
ible requisition  of  the  truth. 


40 


SELF-LIMITED    DISEASES. 


NOTES. 


NOTE  A. 

THE  difficulty  of  discriminating  between  the 
symptoms  of  disease,  and  the  effects  of  treat- 
ment, has  undoubtedly  led  to  much  erroneous 
practice,  so  that  we  cannot  be  too  careful  or 
vigilant,  in  watching  the  consequences  of  our 
own  remedies.  For  a  long  time  the  effects  re- 
sulting from  an  excessive  use  of  mercury,  were 
mistaken  for  the  phenomena  of  syphilis.  The 
arterial  reaction,  described  by  Marshall  Hall, 
which  sometimes  follows  excessive  blood-letting, 
has  been  confounded  with  the  arterial  action  of 
disease  requiring  further  depletion.  Constitu- 
tional irritation,  produced  or  kept  up  by  an 
inordinate  use  of  vesicatories  and  other  counter- 
stimulants,  has  been  made  a  reason  for  the 
farther  continuance  of  those  applications.  Much 
acute  and  unnecessary  suffering  has  been  caused 
by  the  prolonged  application  of  sinapisms  to  the 


NOTES.  41 

tender  skins  of  infants,  and  the  limbs  of  dying 
patients.  The  pains  of  hunger,  resulting  from 
a  too  restricted  diet,  are  most  keenly  felt  by 
convalescents  from  sickness  ;  yet  we  sometimes 
see  the  cries  of  infants,  arising  from  this  cause, 
mistaken  for  signs  of  disease,  and  met  by  the 
practitioner  with  medicines,  and  farther  restric- 
tions. I  do  not  speak  of  these  things  as  com- 
mon occurrences,  yet  they  have  been  sufficiently 
so,  to  render  it  obvious  that  circumspection,  on 
the  part  of  the  practitioner,  is  necessary  to  avoid 
them. 

NOTE  B. 

The  vaccine  vesicle  might,  if  it  were  desired, 
be  extirpated  by  the  knife  or  caustic,  although  if 
the  vesicle  be  sufficiently  developed  to  excite  no- 
tice, the  surgical  remedy  would  be  at  least  as  bad 
as  the  disease.  In  regard  to  medical  remedies, 
I  have  had  occasion  to  observe  their  inefficiency 
in  cases  where  inflammatory  diseases,  requiring 
treatment,  have  occurred  during  the  progress  of 
cow  pox.  The  depletive  remedies  employed 
for  the  former  diseases  did  not  affect  the  pro- 
gress of  the  vaccine  vesicle.  When  this  vesicle 


42  SELF-LIMITED    DISEASES. 

is  slow  and  diminutive,  it  is  commonly  owing 
to  the  coexistence  of  some  other  cutaneous 
affection. 

In  regard  to  mercurial  salivation,  although 
the  treatment  proposed  by  Dr.  Pearson  and 
others,  may  have  been  reiterated  in  many  vol- 
umes, yet  I  believe  that  most  practitioners  of 
experience  find  themselves  obliged  to  rely  upon 
time  and  palliatives,  aided  by  the  withdrawal  of 
the  cause. 

NOTE  C. 

The  modern  introduction  of  the  non-mercurial 
treatment  in  syphilis,  might  almost  lead  us  to 
consider  this  malady  also,  as  among  the  self- 
limited  diseases.  Although  syphilis,  as  it  exist- 
ed in  the  days  of  Mr.  Hunter,  appears  to  have 
yielded  to  mercury  alone,  so  that  this  eminent 
author  regarded  it  as  one  of  the  distinguishing 
traits  of  the  disease,  that  it  had  no  tendency  to 
spontaneous  recovery  ;  yet  the  experience  of  the 
last  twenty  years  has  shown  that  syphilis,  as  it 
now  exists  in  all  its  prominent  varieties,  has 
been  cured  in  many  thousands  of  cases,  by  a 
treatment  in  which  no  mercury  in  any  shape  is 


NOTES.  43 

employed.  Nevertheless,  the  treatment  by  the 
anti-phlogistic  method,  which  has  been  substi- 
tuted, requires,  in  order  to  be  successful,  more 
or  less  depletion,  abstinence,  and  positive  rest, 
conjoined  occasionally  with  other  remedies.  So 
that  the  disease  still  undergoes  efficient  treat- 
ment ;  and  indeed,  when  it  is  wholly  neglected, 
as  it  sometimes  is  by  the  abject  and  the  reck- 
less, it  results  in  the  most  deplorable  conse- 
quences, of  which  our  hospitals  and  almshouses 
furnish  sufficient  and  frequent  examples. 


NOTE  D. 

Corvisart  died  of  a  disease  of  the  heart ; 
Laennec  and  Armstrong  of  pulmonary  con- 
sumption. Other  examples  may  be  found  of 
persons  who  were  writers  on  the  diseases  of 
which  they  afterwards  died. 

NOTE  E. 

Ulceration  in  the  tonsils  and  palate  is  the 
most  common  lesion  in  scarlatina,  but  the  other 
morbid  appearances  discovered  in  autopsies  of 


44  SELF-LIMITED    DISEASES. 

cases  of  this  disease  are  exceedingly  various  and 
uncertain.  Among  those  which  I  have  observed, 
or  which  have  been  noticed  by  my  medical 
friends  in  this  city,  are  ulcerations  in  the  larynx, 
and  inflammation  of  the  mucous  membrane  of 
the  trachea  and  bronchiae.  In  one  case  of  thirty- 
six  hours  duration,  the  chief  morbid  appearance, 
in  addition  to  the  ulcerated  throat,  was  an  ex- 
tensive peritonitis  with  effusion  of  coagulating 
lymph  lining  most  of  the  abdominal  cavity. 
Serous  effusions  in  and  upon  the  brain  have 
been  occasionally  noticed,  but  most  frequently 
in  the  secondary  forms  of  the  disease.  In  the 
child  of  an  eminent  physician  in  this  city,  whose 
case  and  autopsy  I  witnessed,  there  was  slight 
ulceration  of  the  tonsils,  but  no  lesion  of  any 
important  viscus  could  be  detected,  though  dili- 
gently sought  for  by  our  best  pathological  anat- 
omists. Two  similar  cases  have  been  stated  to 
me,  and  I  find  them  also  noticed  by  some  wri- 
ters on  the  disease.  In  these  cases  the  poison 
of  the  disease  seems  to  destroy  life,  without 
exciting  inflammatory  action. 

Family  predisposition    appears   to  influence 
the   tendency  to   mortality   in   scarlatina.      In 


NOTES.  45 

some  cases  the  children  of  a  family  all  die  in 
rapid  succession.  A  predisposition  to  take  the 
disease  seems  also  affected  by  the  same  cause, 
so  that  it  sometimes  operates  during  the  same 
season-upon  members  of  the  same  family  resid- 
ing in  different  places,  without  personal  inter- 
course. 

The  latent  period  between  the  inception  and 
development  of  this  disease  appears  subject  to 
great  variation.  I  knew  a  patient  to  be  taken 
with  scarlet  fever  in  forty-eight  hours  after 
arriving  in  this  country  by  a  passage  of  forty 
days  from  Europe.  In  this  instance,  as  no  case 
existed  in  the  ship,  the  latent  period  must  have 
been  less  than  two  days,  or  more  than  forty. 

Scarlatina  and  some  other  eruptive  fevers 
reciprocally  affect  the  development  of  each 
other.  During  the  prevalence  of  measles  and 
scarlet  fever  in  this  city  in  the  winter  and  spring 
of  1832,  a  considerable  number  of  cases  occur- 
red, in  which  the  two  diseases,  each  preserving 
its  own  distinctive  character,  were  successively 
passed  through  by  patients,  without  quitting 
their  beds,  yet  the  diseases  were  in  no  wise 
blended,  or  intermixed.  In  the  family  of  a  lady 


46  SELF-LIMITED    DISEASES. 

Tesiding  in  Tremont  Place,  five  individuals  had 
scarlet  fever,  and  three  of  them  measles,  nearly 
at  the  same  time.  The  circumstances  are  in- 
teresting. One  child  had  measles  first,  the  dis- 
appearance of  which  was  immediately  followed 
by  scarlatina;  both  diseases  proved  mild,  and 
were  completed  in  about  twenty  days.  Another 
child  had  severe  scarlatina  with  a  bad  throat, 
the  ulcers  of  which  were  not  healed  before  the 
sixteenth  day.  After  this  the  patient  remained 
stationary,  with  a  quick  pulse,  and  without 
return  of  appetite  or  strength  for  several  days 
more,  when  the  eruption  of  measles  appeared 
under  the  cuticle  which  was  desquamating  from 
scarlatina,  and  passed  through  its  regular  course. 
A  third  child  in  the  same  family  was  affected 
in  a  more  singular  manner.  The  eruption  of 
measles  appeared  first,  with  slight  catarrh al 
symptoms,  and  continued  one  day.  It  then 
vanished,  and  was  in  two  days  succeeded  by 
scarlet  fever.  This  lasted  about  a  week,  and 
•when  the  patient  was  expected  to  get  well,  the 
'crimson  eruption  of  measles  reappeared,  and 
lasted  three  days  more.  In  these  cases  the  two 
diseases,  though  probably  coexisting  in  the 


NOTES.  47 

body  at  the  same  time,  and  in  the  last  case 
decidedly  so,  were  never  extant  at  once  in  an 
active  or  characteristic  form.  There  was  no 
reason  to  suppose  that  the  intensity  of  either 
disease  was  diminished,  or  aggravated,  by  the 
presence  of  the  other. 

Scarlet  fever  exists  in  some  cases,  where  its 
presence  is  not  suspected,  as  the  following  cases, 
selected  from  a  number  of  similar  ones,  may 
show.  A  child,  previously  well,  was  taken  in 
fits  at  night,  and  died  on  the  following  morning. 
As  the  disease  was  not  epidemic  at  the  time, 
the  nature  of  the  complaint  was  not  suspected 
till  a  few  hours  before  death,  when  another 
child  coming  out  with  the  eruption,  this  circum- 
stance led  me  to  an  examination  of  the  throat 
of  the  first,  which  was  found  ulcerated.  In 
another  case,  a  child  was  affected  with  a  very 
troublesome  rheumatic  stiff  neck.  On  inquiry, 
it  was  ascertained  that  a  scarlet  efflorescence 
had  existed  on  the  preceding  week,  of  which  the 
rheumatism  was  doubtless  a  sequel,  though  the 
nature  of  the  eruption  had  not  been  appre- 
hended. 

The  sequelae  or  secondary  effects  of  scarlet 


48  SELF-LIMITED    DISEASES. 

fever  are  extremely  various.  Rheumatic  affec- 
tions are  among  the  most  common.  Dropsical 
effusions  are  frequent,  both  in  the  cellular  tex- 
ture and  in  large  cavities.  Anasarca  and  ascites 
are  not  of  uncommon  occurrence.  I  have  seen 
hydrocele,  which  disappeared  spontaneously  in 
a  few  weeks,  and  hydrocephalus  which  proved 
fatal.  Troublesome  indurations  of  the  parotid 
and  submaxillary  glands  often  occur,  and  may, 
or  may  not,  be  followed  by  suppuration.  A 
fatal  induration  of  the  whole  anterior  neck  is 
sometimes  met  with.  This  I  have  seen  both  in 
the  primary  and  secondary  disease.  A  purulent 
or  sanious  discharge  from  the  ears  occasionally 
follows  scarlet  fever,  and  sometimes  continues 
long  enough  to  destroy  the  organic  texture,  and 
with  it  the  sense  of  hearing,  in  one  or  both  ears. 
Erysipelas  and  roseola  are  among  the  other 
pearances  which  I  have  seen  to  supervene  upon 
this  uncertain  disease.  Fortunately,  however, 
the  largest  portion  of  cases  are  attended  with  no 
sequelas,  or  with  such  as  disappear  spontane- 
ously in  their  own  time,  without  permanent 
injury  to  the  patient 


NOTES.  49 

NOTE  R 

We  have  sufficient  evidence  that  many  cases 
of  gout,  both  in  this  country  and  Europe,  have 
had  their  paroxysms  abridged  by  the  use  of 
colchicum,  and  different  species  of  veratrum. 
Some  individuals  are  fortunate  enough  to  obtain 
this  effect  under  a  moderate  dose,  which  only 
affects  the  bowels.  But  in  most  persons  it  is 
necessary  to  take  enough  of  the  medicine  to 
produce  vomiting  and  temporary  prostration, 
before  the  desired  result  can  be  obtained.  This 
effect  is  sometimes  so  severe  that  many  patients 
prefer  the  disease  to  the  remedy,  and  in  fact  the 
practice  is  hardly  warranted  in  the  case  of  very 
feeble  or  aged  persons. 

Three  cases  have  occurred  to  me,  in  which 
gout  has  disappeared  altogether  under  an  entire 
abstinence  from  spirituous  and  fermented  liquids. 
In  one  of  these  it  is  now  thirteen  years  since  a 
paroxysm  occurred,  and  in  another  seven  years, 
the  individuals  both  enjoying  good  health,  and 
leading  active  lives.  The  third  case  was  that 
of  a  gentleman  of  this  city,  lately  deceased  at 
seventy-six  years  of  age,  who  had  suffered  more 
4 


50  SELF-LIMITED    DISEASES. 

than  twenty  years  with  gout,  and  was  reduced 
to  use  crutches.  After  commencing  a  course  of 
entire  abstinence,  the  paroxysms  began  to  abate 
in  violence,  and  for  the  last  seven  years  of  his 
life  he  assured  me  he  had  not  felt  the  sensation 
of  gout.  In  his  last  illness  a  slight  chiragra 
occurred  after  taking  a  dose  of  tincture  of  rhu- 
barb. Some  other  cases  are  now  in  the  progress 
of  trial,  with  apparent  alleviation  of  the  disease. 
I  have  been  told  by  others,  that  this  plan  of 
treatment  has  in  some  instances  failed  to  be 
followed  by  relief,  and  very  probably  this  may 
be  true  ;  but  such  instances  have  not  yet  come 
under  my  personal  observation,  where  the  ex- 
periment has  been  fairly  made  in  the  acute  dis- 


NOTE  G. 

The  natural  history  of  the  small  ascarides  is 
curious,  and  not  well  understood.  Many  indi- 
viduals are  infested  with  them  in  childhood,  but 
get  rid  of  them  as  they  advance  in  years.  Some, 
however,  are  troubled  with  them  during  the 
whole  of  a  long  life,  though  they  are  represented 
as  less  annoying  after  middle  age,  than  before. 


NOTES.  51 

They  most  commonly  appear  periodically,  both 
in  children  and  adults,  after  intervals  of  from 
three  to  six  weeks.  During  the  intervals  they 
are  neither  felt  nor  seen  in  the  discharges. 
Their  periodical  return  is  announced  by  a  sense 
of  itching  and  burning  at  the  extremity  of  the 
rectum,  felt  principally  in  the  evening,  some- 
times producing  tumefaction,  and  eruption  of 
the  neighboring  skin.  This  irritation  continues 
to  recur  every  evening  for  perhaps  a  week,  or 
more,  and  then  ceases.  During  this  time  the 
worms  are  discharged  alive  and  active  in  every 
alvine  evacuation.  Cathartics  and  enemata 
bring  away  vast  numbers  of  them,  but  without 
diminishing  the  annoyance  occasioned  by  those 
which  remain  behind.  At  length  they  sponta- 
neously cease  to  appear,  the  irritation  subsides, 
cathartics  no  longer  bring  them  to  light,  and  the 
inexperienced  practitioner  flatters  himself  that 
the  evil  is  remedied.  Nevertheless,  after  a  few 
weeks,  they  again  return  in  undiminished  num- 
bers, attended  by  the  same  phenomena  as  before. 
Whether  the  new  race  are  cotemporaries  of  the 
old,  or  descendants  from  them,  it  is  not  easy  to 


52  SELF-LIMITED    DISEASES. 

tell  ;  but  the  latter  supposition  seems  most 
probable. 

It  is  commonly  believed  that  the  principal 
•residence  of  ascarides  is  in  the  rectum,  because 
-they  are  most  felt  there.  They  have  been 
found,  however,  in  other  parts, of  the  alimentary 
tube.  Many  patients,  immediately  after  a  ces- 
sation of  the  annoyance  in  the  rectum,  are 
visited  by  pain  in  the  epigastrium,  attended 
'with  costiveness  and  clay-colored  discharges. 
This  state  continues  for  two  or  three  days,  and 
is  then  followed  by  a  bilious  diarrho3a.  I  have 
.repeatedly  known  these  consecutive  events  to 
occur  with  great  regularity  for  half  a  dozen 
years,  so  much  so  that  my  inquiries  are  gene- 
rally directed  towards  this  cause,  when  children 
have  complained  of  epigastric  pains  at  regular 
periods.  Whether,  in  these  cases,  the  worms 
.ascend  to  the  duodenum  and  mouth  of  the 
biliary  duct,  or  whether  the  whole  is  an  affair  of 
.sympathy,  future  autopsies  may  perhaps  de- 
termine. 

The  nidus  of  these  animals,  and  perhaps  the 
food  also,  appears  to  be  the  mucus  which  lines 


NOTES.  53 

the  alimentary  canal.  Buried  in  this  substance, 
they  resist  the  effect  of  the  most  violent  cathar- 
tics and  vermifuges,  oil  of  turpentine  and  croton 
not  excepted.  If  it  be  permitted  to  derive  an 
hypothesis  from  the  phenomena  which  they 
exhibit,  it  would  be,  that  during  a  greater  part 
of  the  time,  they  remain  quietly  embedded  in 
this  mucus,  deriving  from  it  their  habitation  and 
nourishment,  being  at  the  same  time  secured 
from  the  effects  of  the  peristaltic  motion  by 
this  and  by  the  ahhesive  power  of  suction  ;  but 
that  at  certain  periods,  perhaps  at  their  genera- 
ting seasons,  they  issue  forth  from  this  covert, 
and  mingle  themselves  in  the  contents  of  the 
alimentary  canal ;  in  consequence  of  which  they 
are  liable  to  be  expelled  with  the  common  mass. 
I  have  known  ascarides  to  be  eradicated  by  a 
severe  dysentery.  In  some  cases  they  have  been 
totally  removed  by  large  injections  of  oil,  par- 
ticularly of  lamp  oil.  But  more  frequently  they 
resist  these  and  most  other  remedies  for  a  series 
of  years.  A  temporary  palliative  may  always 
be  found  in  small  injections  of  weak  salt  water, 
or  even  of  an  ounce  or  two  of  cold  water. 


54  SELF-LIMITED    DISEASES. 

NOTE  H. 

I  would  by  no  means  undervalue  the  exer- 
tions which  have  been  made,  and  are  still  mak- 
ing by  indefatigable  and  distinguished  men,  for 
the  control  of  what  are  called  pestilential  epi- 
demics. I  would  only  be  understood  to  state 
that  no  one  method  of  treatment,  in  the  diseases 
enumerated,  appears  to  have  acquired  sufficient 
credit  with  the  profession  generally,  to  be  turned 
in  their  hands  to  any  great  practical  account. 
The  records  of  medical  literature  show,  that  a 
period  of  ten  years  has  seldom  elapsed,  without 
the  annunciation  of  some  effectual  mode  of 
practice,  in  some  one  of  these  diseases.  And 
what  is  more,  the  amount  of  evidence  with 
which  these  statements  are  supported,  and  the 
pathological  skill  with  which  the  indications  are 
explained,  seem  sometimes  sufficient  to  shake 
the  incredulity  of  the  most  sceptical.  Neverthe- 
less, after  a  certain  term  of  years  the  diseases 
are  found  to  be  fatal  as  before,  and  fresh  inno- 
vations in  practice  take  the  place  of  the  old, 
and  excite  confidence  anew  among  the  sanguine 
and  ardent  members  of  the  profession.  The 


55 


truth  is,  that  no  epidemic  is  equally  malignant 
in  all  seasons  and  places ;  and  from  some  un- 
known cause,  the  laws  which  affect  its  tendency 
to  death  or  recovery,  are  essentially  different  in 
different  climates  at  the  same  period,  or  in  the 
same  climate  at  different  periods.  This  fact 
must  be  known  to  those  who  have  personal 
experience  in  regard  to  these  diseases,  or  who 
are  conversant  in  their  epidemic  history.  Reli- 
ance, therefore,  cannot  be  justly  accorded  to  any 
mode  of  treatment  which  has  not  had  the  testi- 
mony of  a  large  number  of  years  in  its  favor, 
and  this  also  under  a  proper  variety  of  situations 
and  circumstances.  Were  it  otherwise,  these 
diseases,  in  the  hands  of  the  medical  profession, 
would  long  ago  have  ceased  to  be  pestilences. 


NOTE  I. 

I  am  aware  that  some  of  the  most  distin- 
guished French  pathologists  of  the  present  day 
incline  to  the  opinion  that  many  acute  diseases, 
or  at  least  inflammations,  are  incapable  of  being 
shortened  in  their  duration,  by  art.  [See  mar- 
ginal note,  page  19.]  The  opposite  opinion 


56  SELF-LIMITED    DISEASES. 

prevails  very  generally  in  this  country  and  in 
England,  and  it  would  be  premature  to  consider 
the  question  as  decided,  until  it  has  been  sub- 
mitted more  extensively  to  the  test  of  compara- 
tive numerical  results.  It  is  certain,  that  the 
most  distressing  symptoms  of  acute  inflamma- 
tions are  often  arrested  at  once  by  remedies. 
This  happens,  for  example,  from  blood-letting 
in  croup  and  pleurisy,  and  from  opium  in  stran- 
gury and  dysentery.  If,  however,  the  disease  ia 
fully  established  before  the  application  of  reme- 
dies, it  usually  goes  on  to  complete  its  course, 
and  in  that  case  the  remedies  are  palliatives 
only.  And  if  remedies  be  applied  in  the  in- 
cipient stage,  an  uncertainty  hangs  over  our 
diagnosis,  for  the  supposed  pleurisy  may  have 
been  rheumatism,  and  the  supposed  croup  may 
have  been  catarrh,  or  laryngismus ;  for  even  the 
physical  signs  require  a  certain  maturity  of 
development  in  disease,  to  render  them  satisfac- 
tory. Leaving  then,  as  undecided,  the  question 
of  positive  duration  in  acute  inflammations,  we 
do  not  risk  much  in  asserting  that  their  charac- 
ter is  often  essentially  modified  by  treatment, 
so  that  they  are  more  easily  supported  by  the 


NOTES.  57 

patient,  and '  the  apparent  danger  attending 
them,  diminished.  We  must  wait  for  the 
modern  spirit  of  accurate  inquiry  to  furnish  a 
further  light  on  this  subject. 


NOTE  K. 

As  examples,  it  may  be  stated  that  the  sali- 
vation produced  by  mercury  gets  well  of  itself, 
provided  the  original  cause  is  discontinued. 
An  issue  made  by  caustic,  or  otherwise,  gets 
well  after  the  original  cause  has  ceased  to 
operate ;  but  if  an  accessory  cause  is  present, 
such  as  the  pressure  of  an  irritating  foreign 
substance,  it  then  fails  to  heal.  The  local 
atmosphere  may  be  considered  as  an  original, 
or  an  accessory  cause,  in  those  diseases  which 
are  benefited  by  change  of  climate  or  situation. 
A  long  train  of  diseases  might  be  mentioned, 
which  are  brought  on,  or  kept  up,  by  injurious 
habits  of  life,  and  are  relieved  or  cured,  not  by 
medicines,  but  by  a  removal  of  the  habit  under 
which  they  have  been,  or  continue  to  be,  induced. 
Such  are  the  diseases  which  attend  on  sedentary 
life,  intemperate  indulgences,  lactation,  insalu- 


58  SELF-LIMITED    DISEASES. 

brity  of  diet,  &c.  Sometimes  a  disease,  the 
cause  of  which  is  not  removed,  may  disappear 
in  consequence  of  a  new  habit,  by  which  the 
system  becomes  capable  of  bearing  with  impu- 
nity the  influence  of  this  cause;  as  in  sea- 
sickness. 


TREATMENT  OF  DISEASE: 

AN  INTRODUCTORY  LECTURE,  DELIVERED  BEFORE  THE  MEDICAL 
CLASS  AT  THE  MASSACHUSETTS  MEDICAL  COLLEGE  IN  BOSTON, 
NOVEMBER  3,  1852. 

OF  the  sciences  which  have  most  occupied 
the  time  and  labor  of  mankind,  a  certain  num- 
ber lead  by  their  investigations  to  clear  and 
positive  results,  and  enlarge  the  amount  of 
human  knowledge  by  the  discovery  and  pro- 
mulgation of  absolute  truth.  Another  portion 
lead  only  to  results  which  are  probable  or  pre- 
sumptive in  their  character,  and  which  furnish 
to  mankind  rules  of  action,  in  cases  where  better 
lights  cannot  be  obtained.  To  the  former  class 
has  been  given  the  name  of  exact  sciences,  and 
to  the  latter  the  name  of  presumptive  or  conjec- 
tural sciences.  Mathematics  form  an  exact 
science,  on  the  conclusions  of  which,  when  once 


60 


TREATMENT    OF    DISEASE. 


known,  there  can  be  no  difference  of  opinion. 
In  like  manner,  chemistry  and  mechanics,  as- 
tronomy and  portions  of  natural  history,  are 
examples  of  exact  sciences,  the  demonstrations 
of  which,  when  once  made  clear,  may  after- 
wards be  modified  and  enlarged,  but  are  never 
fundamentally  shaken.  On  the  other  hand,  the 
important  sciences  of  ethics  and  politics,  of 
commerce  and  finance,  of  government,  and 
speculative  theology,  are  inexact  in  many  of 
their  principles,  as  is  proved  by  the  widely 
different  constructions  under  which  men  re- 
ceive and  apply  them  to  practice. 

It  would  at  first  seem  that  the  exact  sciences 
were  those  most  worthy  the  cultivation  of  intel- 
ligent minds,  inasmuch  as  they  lead  to  satisfac- 
tory, and  therefore  to  gratifying  results ;  and 
because,  in  their  more  elevated  departments, 
they  involve  and  require  some  of  the  highest 
reaches  of  the  human  intellect.  But  in  the 
opinions  of  mankind,  as  evinced  by  their  prac- 
tice, the  opposite  judgment  prevails,  and  proba- 
bly nine-tenths  of  the  labor  of  educated  and 
intellectual  men  are  employed  on  studies  which 
are,  in  their  nature,  uncertain  and  conjectural. 


TREATMENT    OF    DISEASE.  61 

The  cause  of  this  great  ascendancy  in  the 
attention  given  to  the  inexact  sciences,  is  to  be 
found  in  the  vast  and  paramount  importance  of 
their  subjects,  and  also  in  the  difficulty  of  con- 
summating their  great  ends.  It  is  much  more 
important  to  mankind  to  know  how  to  avoid 
anarchy  and  crime,  war,  famine,  poverty  and 
pestilence,  than  it  is  to  know  that  the  planet 
Saturn  has  a  ring,  or  that  a  lily  has  six  stamens, 
that  light  can  be  polarized,  or  that  potass  can 
be  decomposed.  Yet  while  the  latter  proposi- 
tions are  susceptible  of  absolute  demonstration, 
the  former  processes,  which  bear  directly  on 
human  happiness  or  misery,  are  frequently  re- 
moved beyond  our  foresight  or  control.  The 
wisest  men  often  fail  to  influence  the  destinies 
of  states,  families,  and  individuals,  and  the 
shrewdest  calculators  are  baffled  in  regard  to  a 
coming  crop,  a  pecuniary  crisis,  a  glut  in  the 
commercial  market,  or  a  change  in  the  public 
morals.  Nevertheless,  the  wise  man,  conscious 
of  superior  talent,  and  the  philanthropist  desi- 
rous of  the  public  weal,  and  even  the  interested 
man  who  looks  to  his  personal  advantage  and 
progress,  must  give  themselves  and  their  ener 


62  TREATMENT    OF    DISEASE. 

gies  to  studies  which  involve  the  immediate 
wants  of  their  fellow-men,  even  though  their 
best  directed  efforts  should  fail  of  the  desired 
results.  And  the  simple  reason  is,  that  if  the 
best  qualified  minds  decline  to  undertake  this 
task,  it  will  most  assuredly  be  assumed  by  the 
ignorant  and  presumptuous. 

Preeminent  among  the  inexact  and  specula- 
tive sciences  stands  practical  medicine,  a  science 
older  than  civilization,  cultivated  and  honored 
in  all  ages,  powerful  for  good  or  for  evil,  pro- 
gressive in  its  character,  but  still  unsettled  in  its 
principles ;  remunerative  in  fame  and  fortune 
to  its  successful  cultivators,  and  rich  in  the  fruits 
of  a  good  conscience  to  its  honest  votaries.  En- 
cumbered as  it  is  with  difficulty,  fallacy  and 
doubt,  medicine  yet  constitutes  one  of  the  most 
attractive  of  the  learned  professions.  It  is 
largely  represented  in  every  city,  village,  and 
hamlet.  Its  imperfections  are  lost  sight  of  in 
the  overwhelming  importance  of  its  objects. 
The  living  look  to  it  for  succor — the  dying  call 
on  it  for  rescue. 

The  greatest  boons  and  the  most  important 
objects  presented  to  our  aspirations  in  this  life, 


TREATMENT    OF    DISEASE.  63 

are  not  to  be  approached  through  paths  which 
are  straight  and  unmistakable.  The  avenues 
to  most  of  them  are  shadowed  by  doubts  or 
clogged  with  incessant  obstacles.  Next  to  the 
spiritual  welfare  of  men,  the  preservation  of 
their  lives,  the  peace  and  safety  of  their  com- 
munities, the  acquirement  and  preservation  of 
their  worldly  goods  are  among  the  objects 
which  take  strongest  hold  on  their  desires. 
Yet  grave  doubts  are  justifiable,  whether  any 
precise  means  have  yet  been  agreed  upon  by 
which  these  desirable  ends  can  with  certainty 
be  attained.  And  if  any  one  deems  it  a  re- 
proach  on  medicine  that  its  cultivators  have 
not  arrived  at  a  common  faith  and  practice,  let 
him  consider  whether  the  laborers  in  other  fields, 
however  honest  their  intentions,  are  agreed  in 
their  theological  creeds  and  political  platforms. 
Considering  the  great  importance  of  the  ob- 
jects of  medicine,  the  frequent  and  earnest 
appeals  made  for  its  assistance,  and  the  vast 
sums  annually  expended  in  its  remuneration,  it 
is  not  surprising  that  disappointment  and  com- 
plaint often  follow  the  failures,  necessary  or 
unnecessary,  of  medical  practice.  'Man  is  of 


64  TREATMENT    OF    DISEASE. 

few  days  and  full  of  trouble.'  Yet  in  the  face 
of  this  acknowledged  truth,  he  requests  and 
expects  that  his  physician  will  provide  him  with 
many  days,  and  remove  at  least  his  bodily 
troubles.  This  expectation  on  his  part  is  rea- 
sonable or  otherwise,  according  to  the  circum- 
stances under  which  it  is  made.  It  is  unrea- 
sonable if  his  case  is  helpless,  and  he  is  merely 
paying  the  debt  of  suffering  and  death  which 
his  mortal  nature  exacts.  But  it  is  reasonable 
and  proper,  if  his  complaint  is  of  a  curable  kind, 
or  if,  whether  curable  or  not,  his  physician  has 
claimed  and  vaunted  the  power  to  remove  it. 

Most  men  form  an  exaggerated  estimate  of 
the  powers  of  medicine,  founded  on  the  common 
acceptation  of  the  name,  that  medicine  is  the 
art  of  curing  diseases.  That  this  is  a  false  Defi- 
nition, is  evident  from  the  fact  that  many  dis- 
eases are  incurable,  and  tjiat  one  such  disease 
must  at  last  happen  to  every  living  man.  A 
far  more  just  definition  would  be,  that  medicine 
is  the  art  of  understanding  diseases,  and  of 
curing  or  relieving  them  when  possible.  Under 
this  acceptation  our  science  would,  at  least,  be 
exonerated  from  reproach,  and  would  stand  on 


TREATMENT    OF    DISEASE.  65 

a  basis  capable  of  supporting  a  reasonable  and 
durable  system  for  the  amelioration  of  human 
maladies. 

Every  young  man  who  proposes  to  become  a 
member  of  the  medical  profession,  should  ask 
himself  whether  he  considers  medicine  a  liberal 
and  honorable  science,  to  be  followed  for  the 
good  it  may  do  to  mankind,  or  as  a  dishonest 
trade,  to  be  pursued  for  the  purpose  of  profiting 
himself  by  the  deception  of  his  fellow-men.  If 
he  accepts  his  profession  in  the  first  sense,  he 
will  strive  to  understand  his  science  in  all  its 
bearings,  and  practise  it  with  conscience  and 
fidelity ;  if  in  the  latter,  he  will  put  his  con- 
science aside,  and  study  only  the  low  arts  which 
entrap  the  credulous  and  unwary. 

With  the  trade  of  medicine  I  have  nothing  to 
do.  Knowing  that  I  address  an  ingenuous  and 
cultivated  audience,  composed  mainly  of  young 
men  who  are  looking  forward  to  an  honest  and 
honorable  place  in  professional  life,  I  make  no 
apology  for  proceeding  to  express  my  belief  of 
the  manner  in  which  medicine  should  be  prac- 
tised and  disease  treated,  for  the  reciprocal 
5 


66  TREATMENT    OF    DISEASE. 

benefit  of  him   who   gives,   and   of  him  who 
receives  its  aids. 

Let  no  one  deceive  himself  by  believing  that 
success,  stable,  permanent,  honorable  success, 
can  be  attained  without  knowledge  of  the  great 
principles  of  the  profession  and  science  of  med- 
icine. This  knowledge  must  consist  in  an 
accurate  acquaintance  with  the  structure  and 
offices  of  the  human  body,  and  the  laws  of  its 
healthy  condition.  After  these  follows  the  sci- 
ence of  pathology,  involving  the  great  and 
fundamental  art  of  diagnosis,  by  which  the  dis- 
eases of  the  human  body  are  detected,  and 
distinguished  rightly  from  each  other.  The 
power  of  distinguishing  diseases  lies  at  the  root 
of  all  correct  and  enlightened  practice,  and 
without  it  all  medical  action  is  empirical  and 
fortuitous.  There  is  no  more  pernicious  error 
than  for  a  physician  to  believe  that  he  can  pre- 
scribe safely  for  the  symptoms  of  a  sick  man, 
without  understanding,  in  some  measure,  the 
nature  of  his  disease.  Symptoms  are  of  various 
import,  according  to  the  seat  of  their  origin  and 
the  nature  of  their  causes ;  and  if  taken  alone 
without  a  correct  interpretation  of  these  attend- 


TREATMENT    OF    DISEASE.  67 

ant  considerations,  they  often  lead  to  a  wrong 
result,  or  to  no  result  at  all.  A  patient  not 
unfrequently  sends  for  a  physician  on  account 
of  a  certain  symptom  which  is  distressing  him, 
and  which  may  be,  for  example,  a  pain  in  the 
abdomen,  or  in  the  head.  Now  a  pain  in  the 
abdomen  may  arise  from  colic  or  peritonitis, 
from  rheumatism  or  neuralgia,  from  dysentery, 
from  calculus,  carcinoma  or  strangulation.  And 
in  like  manner,  a  pain  in  the  head  may  arise 
from  a  multitude  of  different  and  even  opposite 
causes.  Now  it  is  well  known  that  the  kind  of 
treatment  which  is  effectual  in  one  case,  is  per- 
nicious in  another ;  and  he  who  prescribes  for 
the  symptom  irrespectively  of  the  cause,  is  quite 
as  likely  to  do  mischief  to  his  patient  as  good, 
and  quite  as  likely  to  destroy  life  as  to  save  it. 

If  the  question  be  asked,  what  makes  a  great 
physician,  and  one  who  is  appealed  to  by  his 
peers,  and  by  the  discerning  portion  of  the  pub- 
lic, for  counsel  in  difficult  cases,  I  would  answer, 
that  he  is  a  great  physician  who,  above  other 
men,  understands  diagnosis.  It  is  not  he  who 
promises  to  cure  all  maladies,  who  has  a  reme- 
dy ready  for  every  symptom,  or  one  remedy  for 


Ob  TREATMENT    OF    DISEASE. 

all  symptoms ;  who  boasts  that  success  never 
fails  him,  when  his  daily  history  gives  the  lie  to 
such  assertion.  It  is  rather  he,  who,  with  just 
'discrimination,  looks  at  a  case  in  all  its  difficul- 
ties ;  who  to  habits  of  correct  reasoning,  adds 
the  acquirements  obtained  from  study  and  ob- 
servation ;  who  is  trustworthy  in  common  things 
for  his  common  sense,  and  in  professional  things 
for  his  judgment,  learning,  and  experience  ;  who 
forms  his  opinion  positive  or  approximative, 
according  to  the  evidence ;  who  looks  at  the 
necessary  results  of  inevitable  causes ;  who 
promptly  does  what  man  may  do  of  good,  and 
carefully  avoids  what  he  may  do  of  evil.  Ex- 
amples are  rare  of  this  perfection,  yet  for  an 
approach  to  such  a  standard  of  professional 
excellence,  I  would  venture  to  direct  your  re- 
membrance to  the  venerable  ex-professor,  fortu- 
nately yet  among  us,  of  the  theory  and  practice 
in  this  University. 

Every  citizen  whose  capacity  is  able  to  reach 
the  ordinary  affairs  of  life,  is  aware  that  the 
persons  most  capable  of  discharging  the  com- 
mon offices,  or  of  exercising  the  common  arts 
and  duties  of  life,  are  the  individuals  who  have, 


TREATMENT    OF    DISEASE.  OiJ 

by  talents,  education  and  practice,  become  EX- 
PERTS in  those  arts  and  duties  ;  —  and  that,  on 
the  other  hand,  those  persons  who  profess  to 
have  acquired  knowledge  by  intuition,  to  have 
become  learned  withput  labor,  and  to  have 
arrived  by  short  cuts  at  results  and  qualifications 
which  demand  years  of  preparatory  training, 
must  be  incompetent  and  treacherous  sources  of 
reliance.  And  it  is  the  general  admission  of 
this  truth  which  gives  support  and  confidence 
to  the  various  professions,  arts  and  callings,  to 
which  men  devote  their  lives. 

A  little  machine  called  a  watch  is  carried 
about  by  most  persons,  and  when  this  machine 
has  stopped  or  is  out  of  order,  they  do  not  lay 
their  own  ignorant  hands  upon  it,  but  submit 
the  case  to  the  skill  of  an  expert,  who  is  known 
to  be  qualified  to  judge  and  act  in  such  cases. 
It  is  the  duty  of  this  artist  when  applied  to,  to 
examine  the  interior  of  the  watch,  to  ascertain 
by  the  use  of  his  skill,  in  what  part  the  disease 
is  situated,  and  to  apply  to  that  part  the  appro- 
priate remedy.  If  a  spring  or  a  chain  is  broken, 
it  must  be  restored;  if  the  wheels  are  out  of 
gear,  they  must  be  put  in  place ;  if  the  hands 


70  TREATMENT    OF    DISEASE. 

only  have  caught,  they  have  only  to  be  liberated, 
and  if  the  pivots  are  dry  and  rough,  they  must 
be  oiled  or  cleaned;  —  and  lastly,  if  the  watch 
has  had  a  destructive  fall,  if  it  has  been  crushed 
by  being  trodden  on,  if  it  has  lain  a  month  in 
the  salt  water,  or  if  it  is  worn  out  by  running 
steadily  for  threescore  years  and  ten,  then  the 
case  is  incurable,  and  the  only  palliative  advice 
which  the  practitioner  can  render  is,  that  the 
owner  should  procure  a  new  watch,  or  reconcile 
himself  to  do  without  one. 

But  suppose  there  resides  in  the  place  a 
watch  doctor  who  prescribes  for  symptoms,  and 
who,  among  other  things,  has  a  remedy  for  the 
symptom  of  stopping,  and  that  this  remedy  con- 
sists in  a  certain  kind  of  friction,  shaking,  or 
manipulation,  an  ointment  applied  to  the  out- 
side, or  an  invisible  particle  of  some  nugatory 
substance  inserted  into  the  inside  ;  and  suppose 
that  one  or  two  watches  in  a  hundred  which 
had  stopped  by  accident,  should  by  accident 
resume  their  motions  under  such  treatment, 
could  anything  but  the  most  unmitigated  folly 
draw  the  inference  that  such  a  person  is  entitled 
to  become  the  accredited  horologer  to  the  com- 
munity ? 


TREATMENT    OF    DISEASE.  71 

What  is  so  conspicuously  true  in  the  common 
business  of  life,  is  only  an  example  of  what  is 
more  vitally  true  in  the  practice  of  medicine. 
If  a  man  has  had  the  misfortune  to  get  a  shot 
or  a  stab  in  his  body,  he  does  not  need  a  doctor 
who  administers  a  specific  dose  or  a  sovereign 
plaster  for  holes  in  the  body ;  he  wants  a  man 
who  can  tell  him  whether  the  wound  has  passed 
inside  or  outside  of  his  peritoneum,  and  whether 
it  is  requisite  for  him  to  make  his  will,  or  to 
make  arrangements  for  pursuing  his  journey. 

But  the  prescribing  for  symptoms  in  the  dark 
is  not  the  only  instance  in  which  false  logic  has 
entered  into  medical  reasoning.  It  is  not  less 
absurd  to  suppose  that  disconnected  events, 
which  have  closely  followed  each  other,  have 
therefore  a  necessary  dependence  upon  each 
other.  Shrewd,  practical  men  do  not  thus  gov- 
ern themselves  in  the  common  affairs  of  life. 
A  merchant  about  to  send  a  ship  -to  sea,  en- 
deavors to  find  a  captain  to  take  charge  of  her 
who  understands  navigation,  who  can  keep  his 
run  and  determine  his  place,  who  studies  the 
weather  and  is  on  the  lookout  for  a  lee  shore, 
and  who  in  emergencies  can  judge  whether  it  is 


TREATMENT    OF    DISEASE. 

necessary  or  not  to  cut  away  the  masts  or  throw 
over  the  cargo.  But  suppose  a  man  appears, 
and  such  have  been,  who  announces  that  he  has 
a  specific  bottle  of  oil  with  which  he  cures 
tempests,  and  by  pouring  a  teaspoonful  of  which 
upon  the  waves,  the  storm  is  speedily  made  to 
cease  !  Would  any  prudent  owner  intrust  his 
vessel  to  such  a  man  and  on  such  grounds,  even 
though  he  should  produce  a  hundred  certificates 
that  storms  had  stopped  in  half  a  day,  or  half 
an  hour  after  the  application  of  his  remedy  ? 
For  these  certificates,  if  true,  would  only  prove 
that  in  a  certain  number  of  cases,  a  result  had 
followed  by  accident,  which  common  sense,  and 
if  necessary,  a  thousand  opposite  cases  would 
show  had  nothing  to  do  with  the  pretended 
cause. 

What  would  be  true  of  the  apparent  or  al- 
leged cure  of  a  tempest  at  sea,  is  no  less  true  of 
the  pseudo-cures  which  every  day  take  place  in 
diseases  which  are  self-limited,  paroxysmal  or 
recidivous  in  their  character.  There  are  doubt- 
less living  many  men  who  believe  themselves  to 
have  been  cured  half  a  dozen  times  of  various 
diseases,  of  fevers  and  inflammations,  of  neu- 


TREATMENT    OF    DISEASE.  73 

ralgia,  rheumatism,  gout  and  asthma  ;  and  each 
time  perhaps  by  a  different  remedy,-but  who  on 
the  next  imprudence  or  returning  period,  are 
destined  to  find  themselves  feverfsh,  neuralgic, 
gouty,  or  asthmatic  still. 

Deceptions  in  medicine  are  occasioned  not 
only  by  the  dishonesty  of  charlatans,  but  quite 
as  often  by  the  well-meaning  credulity  of  other 
practitioners,  whose  intellect  is  impulsive,  or 
whose  education  has  been  unduly  curtailed. 
It  is  so  flattering  to  a  man's  self-love  to  believe 
that  his  chance  shots  have  sometimes  taken 
effect,  that  physicians  of  regular  position  may 
pass  their  lives  in  mere  speculative  and  random 
efforts  at  curing  diseases,  shutting  their  eyes 
against  their  own  failures,  and  not  allowing 
themselves  to  consider  that  in  a  certain  portion 
of  successful  cases  which  they  had  failed  to 
understand,  the  disease  in  truth  got  well  with- 
out, or  perhaps  in  spite  of,  their  misdirected  and 
embarrassing  practice. 

Medicine  is  a  great  good  and  an  unquestion- 
able blessing  to  mankind,  when  it  is  adminis- 
tered by  discriminating  and  intelligent  hands 
with  sincerity  and  good  judgment.  It  disap- 


74  TREATMENT    OF    DISEASE. 

points  expectation,  and  fails  to  accomplish  its 
mission,  when  the  agent  who  dispenses  it  falls 
into  the  mistaken  resource  of  professing  infalli- 
bility, and  of  raising  hopes  which  he  knows  not 
how  to  accomplish.  No  man  is  deemed  to  be 
safe  in  his  worldly  affairs  who  is  afraid  to  look 
into  his  own  pecuniary  condition.  Neither  is  a 
physician  safe  in  his  practice  or  his  reputation, 
who  is  afraid  to  face  the  case  of  his  patient  in 
all  its  bearings.  That  man  is  most  to  be  relied 
on  who  looks  calmly  and  understandingly  at 
the  emergency  before  him,  who  knows  the  im- 
port of  signs,  and  deduces  from  them  the  proba- 
ble tenor  of  coming  events ;  who  is  aware  of 
the  great  truth  that  all  men  must  die,  but  is 
also  aware  of  the  more  gratifying  truth  that 
most  sick  men  recover ;  and  who,  in  particular 
exigencies,  inquires  of  his  reason  and  his  knowl- 
edge, in  which  of  these  two  immediate  catego- 
ries his  patient  is  placed,  and  how  far  the  event 
of  the  case  is  within  his  control.  He  will  then 
interfere  or  he  will  wait,  he  will  act  or  he  will 
forbear,  as  he  only  knows  how  who  can  form  a 
correct  verdict  from  the  evidence  before  him, 


TREATMENT    OP    DISEASE.  75 

and  who    knows   the    immeasurable    good  or 
harm  which  hangs  on  medical  practice. 

The  vulgar  standard  of  medical  character  de- 
pends very  much  on  the  supposed  successful 
result  of  cases.  But  this  is  not  the  true  stand- 
ard, for  the  best  physicians  as  well  as  the  most 
popular  practitioners,  often  lose  their  patients, 
and  even  their  own  lives,  from  common  diseases ; 
while,  on  the  other  hand,  the  most  injudicious 
treatment,  and  the  most  reckless  exposures  are 
not  unfrequently  survived.  Laennec  and  Bichat, 
two  of  the  most  distinguished  lights  of  modern 
medicine,  died  of  the  very  diseases  they  were 
themselves  investigating.  Preissnitz,  the  prince 
of  modern  empirics,  himself  a  robust  peasant, 
died  of  premature  disease  at  the  age  of  fifty- 
two,  in  the  midst  of  his  own  water-cure.  It  is 
well  known,  that  the  most  thronged  and  popu- 
lar places  of  resort  for  grave,  difficult,  and 
intractable  cases,  are  those  from  which  there 
are  most  funerals.  On  the  other  hand,  men 
support  life  in  certain  cases  under  every  extreme 
of  opposite  treatment,  under  ultra-depletion  and 
ultra-stimulation,  under  heroic  practice  and 
nugatory  practice,  under  « hot  drops '  and  cold 


76  TREATMENT    OF    DISEASE. 

douches,  under  drachm  doses  of  calomel,  and 
imponderable  doses  of  moonshine.  Clot  Bey, 
and  his  two  or  three  associate  Frenchmen, 
entered  a  plague  hospital  at  Cairo  in  the  height 
of  the  epidemic.  They  shut  themselves  up  in 
the  concentrated  atmosphere  of  the  infection, 
they  remained  in  bed  in  contact  with  dying 
patients,  they  wore  the  shirts  of  those  who  had 
just  expired,  they  inoculated  themselves  with 
the  secretions  of  pestilential  buboes,  —  and  all 
to  no  purpose.  They  were  alive  some  years 
afterwards,  and  quarrelling  with  each  other  for 
the  glory  of  their  hair-brained  enterprise.  Four 
thieves  in  the  plague  at  Marseilles  freely  prose- 
cuted their  robberies  in  the  infected  houses  of 
the  dead  and  dying;  and  the  aromatic  vinegar, 
whichrhas  immortalized  their  prophylactic  prac- 
tice, was  very  probably  an  impromptu  invention 
brought  forward  by  them  to  procure  their  ex- 
emption from  punishment. 

The  humility  which  we  may  learn  from  the 
limited  influence  of  our  art  on  the  health  and 
lives  of  mankind,  is  probably  a  far  safer  guide 
to  a  correct  practice,  than  the  fanatical  confi- 
dence with  which  unenlightened  ultraists  of 


TREATMENT    OF    DISEASE.  77 

every  sect  carry  out  their  respective  dogmas. 
In  a  sphere  of  action  where  some  good  may 
always  be  done,  and  where  much  harm  often  is 
done,  and  'fools  rush  in  where  angels  fear  to 
tread,'  it  is  well  to  consider  some  of  the  rules 
which  may  lead  an  honest  inquirer  after  truth 
to  the  nearest  attainment  to  a  correct  judgment 
and  practice. 

Supposing,  what  I  would  fain  wish  might 
always  happen,  that  the  physician  is  duly  and 
thoroughly  imbued  with  knowledge  of  his  sci- 
ence, the  first  great  question  which  presents 
itself  in  every  case  or  emergency,  is  that  which 
involves  the  diagnosis.  This  being  established, 
the  practitioner  is  enabled  to  avail  himself  of 
the  lights  of  reason  and  experience  in  regard  to 
a  correct  course  of  therapeutic  proceeding.  But 
it  often  happens  that  the  nature  of  the  case 
cannot  be  made  out  in  one,  or  two,  or  three 
interviews  with  the  patient,  and  we  are  obliged 
to  wait  for  the  gradual  development  of  diagnos- 
tic symptoms,  as  a  judge  and  jury  in  a  like  case 
would  be  expected  to  postpone,  or  wait  for  the 
arrival  of  witnesses.  It  is  a  mistaken  pride 
which  leads  physicians  to  commit  themselves 


78  TREATMENT    OF    DISEASE. 

by  an  oracular  guess  at  first  sight,  which  the 
events  of  the  succeeding  day  may  show  to  have 
been  erroneous.  Moreover,  if  from  the  obscure 
character  of  the  case,  or  the  imperfection  of  our 
science,  diagnosis  is  impossible,  we  should  then 
so  generalize  our  treatment  that  we  may  include 
what  is  possible  of  good,  and  exclude  what  is 
probable  of  harm. 

Having  settled,  as  well  as  our  means  admit, 
the  pathological  condition  of  our  patient,  the 
next  question  is  that  which  regards  the  probable 
tendency  of  the  disease  if  left  to  itself.  Atten- 
tion to  this  point  is  of  high  importance,  since  it 
will  prevent  us  from  neglecting  our  patients  in 
grave  and  dangerous  affections,  as  well  as  from 
annoying  them  with  useless  appliances  in  short, 
safe  or  unimportant  cases.  Many  diseases  are 
insidious  in  their  origin.  The  nervous  imbe- 
cility which  has  its  foundation  laid  in  modern 
schools,  the  slight  cough  and  evening  flush 
which  herald  approaching  phthisis,  soon  get 
beyond  the  reach  of  medical  means,  unless  sea- 
sonably detected  by  the  wary  eye  of  the  prac- 
titioner. A  simple  discharge  from  the  ear  may 
terminate  in  deafness,  and  an  ulcer  of  the  cornea 


TREATMENT    OF    DISEASE.  79 

in  loss  of  sight.  A  protracted  intermittent  at 
length  undermines  the  health,  and  neglected 
syphilis  ends  in  a  miserable  death.  Cases  like 
these  require  prompt  and  energetic  interference 
on  the  part  of  the  practitioner.  On  the  other 
hand,  diseases  which  are  light  in  themselves, 
and  tend  to  speedy  recovery,  as  common  catarrh, 
hooping  cough,  varicella,  and  a  host  of  other 
things,  if  they  occur  in  healthy  subjects,  and 
are  not  complicated  with  graver  affctions,  may 
safely  be  left  to  themselves,  or  treated  with  the 
mildest  remedies  and  cautionary  measures. 

Another  most  important  question,  exercising 
the  hopes  and  fears  of  every  practitioner,  from 
its  connection  with  reputation,  safety  and  life, 
is  that  which  relates  to  the  curability  of  dis- 
eases. Is  the  disease  amenable  to  medical 
treatment,  or  not  ?  If  the  case  is  of  a  recovera- 
ble character,  and  happily  a  great  majority  of 
our  cases  are  so,  the  physician  should  anxiously 
and  carefully  have  recourse  to  the  recorded 
authorities  of  his  science,  and  to  his  own  per- 
sonal experience.  In  doing  this  he  should  be- 
ware of  implicitly  trusting  those  who  have 
published  only  the  favorable  side  of  their  prac- 


80  TREATMENT    OF    DISEASE". 

tice,  preferring  to  build  up  a  temporary  reputa- 
tion rather  than  to  promulgate  unpopular  truths. 
And  in  analyzing  his  own  experience,  he  should 
equally  beware  of  hasty  generalizations,  of  im- 
pressions made  by  remarkable  examples,  rather 
than  by  aggregates  of  well  observed  and  duly 
arranged  cases,  from  which  alone  impartial  and 
correct  inferences  are  to  be  drawn. 

In  accordance  with  such  views,  we  shall  find 
many  cases  which  are,  for  the  most  part,  capa- 
ble of  being  arrested  or  broken  up  by  the  inter- 
position of  remedies.  Thus  the  grave  and 
various  symptoms  which  result  from  an  over- 
loaded stomach,  are  at  once  removed  by  the 
action  of  an  emetic,  or  sometimes  of  a  laxative  ; 
colic  in  like  manner  yields  to  opium  or  to  pur- 
gatives ;  syphilis  is  cured  by  mercury,  and 
sometimes  without  it;  and  certain  inflammatory 
attacks  apparently  yield  to  seasonable  depletion. 
Moreover,  in  other  cases  which  cannot  be  thus 
arrested,  but  which,  from  their  nature,  must  run 
a  destined  course,  it  is  generally  admitted  that 
the  safety  of  the  patient  may  be  promoted,  or 
perhaps  the  duration  of  the  case  abridged  by 
remedial  treatment.  This  is  believed  to  be  true 


TREATMENT    OF    DISEASE.  81 

in  regard  to  evacuations  at  the  commencement 
of  febrile  and  inflammatory  diseases,  and  to  a 
multitude  of  other  remedies  applicable  in  vari- 
ous cases.  But  on  this  subject  it  is  extremely 
difficult  to  obtain  decisive  and  satisfactory 
knowledge.  It  involves  a  question,  the  settle- 
ment of  which  is  to  be  approached  by  extensive 
and  contrasted  numerical  observations,  a  large 
portion  of  which  yet  remain  to  be  made, 
although  we  have  valuable  contributions  and 
examples  on  many  subjects. 

On  the  other  hand,  when  we  know  that  a 
case  is  self-limited  or  incurable,  we  are  to  con- 
sider how  far  it  is  in  our  power  to  palliate  or 
diminish  sufferings  which  we  are  not  competent 
to  remove.  Here  is  a  most  important  field  for 
medical  practice,  and  one  which  calls  for  an 
exceedingly  large  portion  of  the  time  and  efforts 
of  every  physician.  When  we  consider  that 
most  diseases  occupy,  from  necessity,  a  period 
of  some  days  or  weeks,  that  many  of  them  con- 
tinue for  months,  and  some  for  years,  and  finally 
that  a  large  portion  of  mankind  die  of  some 
lingering  or  chronic  disease,  we  shall  see  that 
the  study  of  palliatives  is  not  only  called  for, 
6 


82  TREATMENT    OF    DISEASE. 

but  really  constitutes  one  of  the  most  common, 
as  well  as  the  most  useful  and  beneficent  em- 
ployments of  a  medical  man. 

In  fhe  use  of  efficient  remedies,  much  depends 
upon  deciding  the  proper  stage  or  time,  to 
which  their  employment  is  applicable.  Some 
curative  agents  can  with  propriety  be  used  only 
at  the  outset  of  the  diseases,  and  if  this  oppor- 
tunity is  lost,  the  remedies  are  afterwards  less 
effectual,  and  perhaps  even  injurious.  Vene- 
section in  the  early  stage  of  certain  acute  dis- 
eases, may  be  productive  of  great  good ;  in  the 
middle  stages  it  is  of  less  benefit,  or  of  none  at 
all ;  and  in  the  latter  stages  it  is  injurious  and 
inadmissible.  On  the  other  hand,  wine  and 
opiates,  which  are  strongly  contra-indicated  in 
the  first  stage,  are  afterwards  not  only  tolerated 
with  impunity,  but  in  certain  cases  are  taken 
with  decided  benefit. 

But,  gentlemen,  the  agents  which  we  oppose 
to  the  progress  of  disease,  may,  by  excessive  or 
ill-timed  application,  become  themselves  the 
pregnant  sources  of  disease.  Every  prudent 
practitioner  is  bound  to  consider  the  effect  and 
tendency  of  the  remedy  he  is  using,  and  to  in- 


TREATMENT    OF    DISEASE.  83 

quire  whether  the  means  employed  to  counter- 
act the  existing  disease,  are  not,  in  their  turn, 
likely  to  produce  evil  to  the  patient ;  and  if  so, 
whether  the  evil  will  be  greater  or  less  than  the 
disease  for  which  they  are  administered.  The 
sudden  healing  of  an  old  ulcer,  issue  or  eruption, 
may  be  followed  by  symptoms  more  serious 
in  their  character  than  those  which  have  been 
removed.  Many  remedial  processes,  if  employ- 
ed in  excess,  or  with  injudicious  frequency, 
result  in  permanent  injury  to  the  patient.  The 
habitual  use  of  active  cathartics,  although 
attended  with  temporary  relief,  seldom  fails  to 
bring  on  or  aggravate  a  permanent  state  of 
costiveness.  Large  and  often  repeated  blood- 
letting, tends  to  the  establishment  of  debility 
and  anemia  in  some  subjects,  or  of  reaction  and 
plethora  in  others.  Opium  and  other  narcotics 
are  in  themselves,  if  abused,  fertile  sources  of 
disease.  The  modern  crying  evil  of  polyphar- 
macy  and  over-medication,  is  profitable  to  the 
druggist,  habitual  to  too  many  physicians,  and 
annoying,  if  not  detrimental,  to  most  patients. 

On  account  of  these  and  similar  considera- 
tions, much  discretion  is  needed  on  the  part  of 


'84  TREATMENT    OF    DISEASE. 

the  physician  to  enable  him  to  judge  rightly  of 
the  kind  of  treatment  which  it  may  be  safe  and 
proper  to  employ,  and  of  the  degree  and  amount 
of  that  treatment,  and  of  the  requisite  length  of 
time  for  its  continuance.  Medical  practice,  in 
many  cases,  points  to  the  direct  substitution  of 
a  positive  good  for  a  positive  evil ;  but  unfortu- 
nately, in  other  cases,  it  admits  only  of  a  choice 
between  evils; — and  in  these  cases  not  only  the 
knowledge  and  experience,  but  also  the  judg- 
ment and  common  sense  of  the  practitioner,  are 
put  in  indispensable  requisition  to  lead  him  to 
.a  correct  issue. 

It  is  wrong  to  suppose,  as  is  often  done,  that 
"the  opportunities  for  doing  good  in  medicine, 
are  limited  to  the  effect  of  specific  remedies,  or 
to  the  application  of  drugs  and  instruments. 
The  enlightened  physician  surveys  the  whole 
:ground  of  his  patient's  case,  and  looks  for  the 
presence  of  any  deleterious  agencies  or  unre- 
moved  causes  of  disease.  Many  morbid  affec- 
tions, which  have  resisted  powerful  remedies, 
cease  speedily  on  the  discovery  and  removal  of 
their  sustaining  cause.  This  is  the  case  with 
various  specific  complaints  produced  by  particu- 


TREATMENT    OF    DISEASE.  ,  85 

lar  drugs  and  stimulants  when  habitually  used. 
A  child  is  often  sick  from  an  error  in  the  diet, 
health  or  habits  of  the  nurse  or  mother.  An 
individual  frequently  suffers  from  the  quality 
and  quantity  of  his  habitual  food  or  drink,  or  of 
his  exercise,  air,  occupation,  or  clothing.  The 
starved  infant  and  the  overfed  gourmand,  the 
drunkard  and  the  ascetic,  the  pale  student  and 
the  emaciated  seamstress,  require  removal  and 
reform,  not  drugs  and  medicines.  A  patient 
dies  of  phthisis  in  a  confined  office  or  a  damp 
northern  climate,  who  might  have  enjoyed  long 
life  in  an  active  occupation  or  a  more  pure  and 
temperate  atmosphere.  On  the  other  hand, 
men  fall  victims  to  the  fevers  and  abdominal 
diseases  of  the  south  and  west,  who  might  have 
escaped  disease  by  a  timely  removal  to  the  north. 
It  is  as  necessary  in  many  cases  that  the  physi- 
cian should  inquire  into  the  situation,  diet, 
habits  and  occupation  of  the  patient,  as  that  he 
should  feel  his  pulse  or  explore  his  chest.  It 
often  happens  that  the  disordered  state  of  the 
one  cannot  be  corrected  until  the  other  has  been 
previously  set  right;  and  a  little  dietetic  instrue- 


86  TREATMENT    OF    DISEASE. 

tion,  or  even  moral  advice,  is  more  serviceable 
than  a  technical  prescription. 

In  regard  to  their  duration,  their  probable 
issue,  and  their  susceptibility  of  relief,  the  phy- 
sician may  profitably  divide  his  cases  into  three 
classes ;  those  which  are  curable,  those  which 
are  temporarily  self-limited,  and  those  which 
are  incurable.*  In  the  first  class,  or  that  of 
curable  diseases,  are  to  be  included  those  mor- 
bid affections  which  we  know,  or  have  reason  to 
believe,  are  under  the  control  of  remedies,  so 
that  they  can  be  arrested,  or  abridged,  in  dura- 
tion. For  the  most  part,  acute  inflammatory 
diseases,  when  not  of  fatal  intensity,  are  mitiga- 
ted by  depletion  and  the  antiphlogistic  regimen, 
more  or  less  actively  enforced,  according  to  the 
degree  of  violence.  Spasmodic  diseases,  on  the 
contrary,  are  influenced  by  opiates,  antispas- 
modics  and  tonics,  and  by  the  removal  of  their 
cause,  when  it  can  be  discovered  and  remedied, 
as  in  the  case  of  dentition,  indigestible  food,  &c. 
Sympathetic  diseases  are  to  be  addressed 
through  the  medium,  organ,  or  texture  which  is 
primarily  affected.  Thus,  a  headache  depend- 

*  See  note,  page  9. 


TREATMENT    OF    DISEASE.  87 

ing  upon  a  disordered  stomach,  or  a  hysteric 
affection  upon  irregularity  of  the  uterine  func- 
tion, are  to  be  treated  under  this  view  of  the 
subject.  Hemorrhages  and  other  morbid  dis- 
charges, are  to  be  dealt  with  by  removing  the 
cause  when  practicable,  by  diminishing  vascular 
activity,  or  by  quieting  the  discharging  sur- 
faces with  opiates,  or  contracting  them  with 
astringents.  There  is  one  class  of  curable  dis- 
eases which  are  controlled  chiefly  by  specific 
remedies,  being  in  some  instances  suspended, 
in  others  radically  removed.  Thus,  gout  is  re- 
lieved by  colchicum,  and  intermittents  by  qui- 
nine and  bark.  Scabies  is  cured  by  sulphur, 
syphilis  by  mercury,  goitre,  as  we  are  informed, 
by  iodine,  and  various  chronic  eruptions  by 
arsenic  and  corrosive  sublimate.  The  foregoing 
examples  will  serve  to  illustrate,  not  only  the 
power  of  medicine,  but  also  the  great  variety  of 
grounds  which  should  govern  medical  practice, 
and  the  importance  of  an  intelligent  diagnosis, 
as  well  as  a  knowledge  of  therapeutic  means. 

In  the  next  subdivision,  or  that  of  self-limited 
diseases,  we  include  those  « which  receive  limits 
from  their  own  nature,  and  not  from  foreign 


TREATMENT    OF    DISEASE. 


influences,  and  which,  after  they  have  obtained 
foothold  in  the  system,  cannot  in  the  present 
state  of  our  knowledge  be  eradicated  or  abridged 
by  art,  but  to  which  there  is  due  a  certain 
succession  of  processes,  to  be  completed  in  a 
certain  time,  which  time  and  processes  may 
vary  with  the  constitution  and  condition  of  the 
patient,  but  are  not  known  to  be  shortened  by 
medical  treatment.'  Examples  are  abundant, 
and  are  found  in  typhus  and  typhoid  fever, 
measles,  small-pox,  hooping  cough,  dysentery, 
and  many  other  diseases  of  lighter  or  graver 
character.* 

It  is  with  regret  that  we  are  obliged  to  ac- 
knowledge the  existence  of  a  third  class,  that  of 
incurable  diseases,  which  has  been  recognized 
in  all  ages  as  the  opprobrium  medicorum.  It 
includes  the  long  train  of  internal  morbid  degen- 
erations, malignant  and  chronic,  by  tubercle  and 
granulation,  by  atrophy  and  hypertrophy,  soft- 
ening and  hardening,  scirrhus,  encephalosis 
ossification,  concretion,  contraction  and  dilata- 
tion, with  their  various  consequences  of  phthi- 
sis, emphysema,  dropsy,  epilepsy,  paralysis,  and 

*  See  marginal  note  t»  page  19. 


TREATMENT    OF    DISEASE.  89 

a  multitude  of  intractable  disorders,  in  which 
organs  are  disabled,  functions  destroyed,  and 
life  itself  rendered  incapable  of  continuance. 

It  is  obvious  that  in  the  three  foregoing  classes 
of  disease,  very  different  modifications  of  treat- 
ment are  required.  In  curable  diseases,  our 
remedial  measures  should  be  prompt  and  ener- 
getic in  proportion  to  the  emergency  of  the 
case,  and  the  certainty  of  benefit  which  is  to 
follow  their  employment.  In  self-limited  dis- 
eases, our  treatment  must  be  of  the  expectant 
character.  It  consists  in  doing  what  we  can 
for  the  comfort  and  safety  of  the  patient,  avoid- 
ing useless  and  troublesome  applications,  watch- 
ing against  accidents  and  complications,  and 
waiting  for  the  salutary  operations  of  nature. 
In  those  maladies  which  are  in  their  nature  in- 
curable, we  are  obliged  to  confine  ourselves  to 
the  palliation  of  suffering,  and  the  removal  of 
causes  which  may  aggravate  the  disease. 

Such,  I  believe,  is  the  true  exposition  of  the 
powers  and  duties  of  every  medical  man.  The 
dignity  of  our  science,  and  the  responsibility  of 
our  profession,  require  that  we  should  form  just 
views  of  the  extent  of  our  capacity  and  duty, 


90  TREATMENT    OF    DISEASE. 

and  that  we  should  not  shrink  from  avowing 
them  to  the  world.  Our  science,  imperfect  as 
it  is,  has  achieved  as  much  as  any  similar  sci- 
ence for  the  prevention,  alleviation,  and  removal 
of  the  evils  which  it  combats.  Let  us  not  bring 
it  into  disrepute,  by  pretending  to  impossibilities, 
by  asserting  what  cannot  be  proved,  and  by  pro- 
fessing what  human  art  is  unable  to  accomplish. 
A  new  era  will  dawn  upon  medicine  when  its 
faithful  and  enlightened  cultivators  shall  more 
constantly  devote  their  time  and  their  efforts  to 
enlighten  the  public  mind  in  regard  to  the  true 
mission  and  powers  of  their  science  ;  and  when 
they  shall  leave  to  charlatans  and  fanatics,  the 
doubtful  and  dishonest  game  of  unfounded 
professional  pretension. 


PRACTICAL    VIEWS 


MEDICAL    EDUCATION. 

PUBLISHED    BY   VOTE   OP   THE  MEDICAL  FACULTY   OF  HARVARD 
UNIVERSITY   IN    1850. 

THE  undecided  state  of  public  opinion  in  re- 
gard to  some  of  the  fundamental  points  in  a 
course  of  medical  education,  including  among 
other  things  the  portion  of  the  term  of  pupilage 
proper  to  be  spent  in  attendance  on  lectures,  is 
thought  to  justify  a  further  consideration  of  the 
subject.  In  some  of  its  relations,  this  subject 
has  already  been  discussed,  in  the  Transactions 
of  the  American  Medical  Association  for  1849, 
in  two  reports,  pages  353  and  359,  to  which  the 
reader  is  particularly  referred.  The  following 
condensed,  but  more  general  view  of  the  subject 
of  medical  education,  is  now  respectfully  sub- 
mitted to  the  members  of  the  Association. 


92  PRACTICAL    VIEWS 

Medical  instruction  should  be  adapted  to  the 
power  of  students  to  receive  and  retain  what  is 
communicated  to  them,  and  should  be  confined 
to  what  is  important  to  them  in  their  subse- 
quent life. 

In  modern  times  the  constituent  branches  of 
medical  science  are  so  expanded,  that  they  are 
not  acquired  by  any  physician  in  a  life-time, 
and  still  less  by  a  student  during  his  pupilage. 
The  same  is  true  even  of  many  individual 
branches.  It  is  not,  therefore,  to  be  conceded 
that '  a  scheme  of  scientific  instruction  should 
embrace  the  whole  science,  and  no  part  should 
be  omitted ; '  nor  that  '  a  well-digested  plan  of 
lectures  embraces  all  that  is  to  be  known  and 
taught.'  Medical  science  has  at  this  day  be- 
come so  unwieldy,  and  contains  so  much  that  is 
unnecessary,  at  least  to  beginners,  that  the 
attempt  to  explain  to  students  the  whole,  is 
likely  to  involve  the  result  of  their  learning  but 
little. 

In  Chemistry,  at  the  present  time,  a  thorough 
adept  is  unknown.  No  man  living  knows  all 
the  recorded  facts,  or  all  that  is  to  be  known 
and  taught,  in  that  science.  Organic  chemistry 


ON    MEDICAL    EDUCATION.  93 

alone  fills  large  volumes,  though  yet  in  its 
infancy. 

In  Materia  Medica  there  are  some  thousands 
of  substances  and  their  compounds,  which  pos- 
sess what  is  called  a  medicinal  power.  Yet  it 
is  not  probable  that  any  physician  effectively 
reads  the  one  half,  or  remembers  one  quarter,  or 
employs  in  his  yearly  practice  one  tenth,  of  the 
contents  of  the  common  dispensatories. 

In  Pathology,  so  complicated  and  various  are 
the  conditions  attendant  on  the  individual  forms 
of  disease,  and  their  relations  with  idiosyncracy, 
temporary  condition  and  external  agency,  with 
organic  lesions  and  functional  disturbances,  that 
few  of  the  most  experienced  pathologists  can  be 
said  to  understand  their  whole  science,  or  to  be 
always  competent  to  its  successful  application. 

In  Etiology,  the  theoretical  literature  of 
causes  has  spread  itself  out  to  an  extent  which 
is  burdensome  and  unprofitable.  It  is  true,  that 
'  man,  from  his  nature,  is  subject  to  suffering, 
disease  and  death  ;'  —  but  it  is  not  equally  ap- 
parent, that  'the  causes  by  which  these  con- 
ditions are  produced,  are  ascertainable.'  We 
know  nothing  of  the  vehicle  of  cholera  or  influ- 


94  PRACTICAL    VIEWS 

enza,  nor  is  it  probably  in  the  power  of  any 
physician,  by  any  art  or  application  of  his 
knowledge,  to  produce  in  a  given  healthy  man 
a  case  of  common  pneumonia  or  of  acute  rheu- 
matism, of  diabetes  or  Bright's  kidney,  of  hyper- 
trophy or  of  cancer,  or  even  of  a  common  boil, 
or  wart. 

In  Therapeutics,  many  hundred  volumes 
exist,  such  as  would  not  have  existed,  could  a 
knowledge  of  the  cure  of  diseases  be  made  so 
easily  tangible,  that  it  could  be  spread  before 
the  student  in  the  three  or  five  years  of  his 
pupilage. 

In  Anatomy,  general  and  special,  microscopic 
and  transcendental; — in  Physiology,  with  its 
intricate  ramifications;  —  in  Surgery,  of  which 
several  subordinate  specialities  constitute  dis- 
tinct living  professions  ;  it  is  not  to  be  admitted 
that  the  means  or  time  of  any  ordinary  course 
of  lectures  can  furnish  full  and  complete  instruc- 
tion. Certainly  it  must  be  difficult  to  arrange 
a  course  of  lectures  on  any  of  the  extensive 
sciences  which  now  constitute  medicine,  if  it  be 
indeed  true,  that  'the  teachers  are  not  justifiable 
in  suppressing  any  portion.' 


ON    MEDICAL    EDUCATION.  95 

it  is  the  business  of  lecturers  in  medical 
schools,  to  condense  and  abridge  the  sciences 
which  they  respectively  teach,  to  distinguish 
their  essential  and  elementary  principles,  to  sift 
carefully  the  useful  from  the  superfluous,  and  to 
confine  the  scope  of  their  teachings,  as  far  as 
possible,  to  what  is  true  and  profitable,  and 
likely  to  be  remembered  and  used  by  their 
hearers.  It  is  unfortunately  too  true,  that,  '  in 
an  extended  system  of  instruction,  there  is  much 
that  the  student  will  not  master,  much  that  will 
have  escaped  his  attention,  much  which  he 
ought  to  know  that  he  has  not  learned.'  The 
remedy  appears  to  be,  to  teach  him  well  what 
he  can  and  should  master,  and  briefly  to  point 
out  to  him  the  sources,  fortunately  abundant, 
from  which  he  may  obtain  the  rest. 

Much  injury  is  done  to  the  cause  of  true 
learning  by  medical  assumption,  amplification, 
and  exaggeration,  by  premature  adoption  of 
novelties,  and  by  tenacity  of  theories,  personal 
or  espoused.  Students,  in  all  former  years, 
have  expended  much  time  in  learning,  what  it 
afterwards  cost  them  both  time  and  trouble  to 
unlearn  ;  —  in  acquiring,  not  merely  the  truths  of 


96  PRACTICAL    VIEWS 

science,  but  the  crude  announcements  and  plau- 
sible doctrines  of  sanguine  or  ingenious  men. 
How  much  time  has  been  wasted  in  some  of 
our  distinguished  seminaries,  in  acquiring  the 
visionary  and  now  neglected  theories  of  Rush 
and  Broussais ! 

The  most  commonly  exaggerated  branch  of 
medical  science  is  therapeutics.  Enlightened 
physicians  well  know  that  many  diseases  are 
incurable,  and  that  others  are  subject  to  laws  of 
duration,  which  cannot  be  interrupted  by  art. 
Yet  students  sometimes  return  from  medical 
schools  persuaded  that  their  instructors  know 
how  to  cure  a  large  part  of  these  diseases,  and 
that  if  others  are  less  fortunate,  it  is  attributable 
to  their  own  fault. 

Medical  teachers  should  keep  pace  with  the 
progress  of  their  respective  sciences.  Yet  in 
their  haste  for  the  promulgation  of  novelties, 
they  should  not  omit  to  give  the  proper  consid- 
eration to  the  older  and  more  settled  principles 
of  science.  Medical  men  are  liable  to  commit 
the  error  of  adopting  premature  opinions,  un- 
sound practice  and  inconvenient  changes  of 
language  and  nomenclature,  sometimes  from  a 


ON    MEDICAL    EDUCATION. 


97 


love  of  display,  and  sometimes  from  a  want  of 
self-reliance,  and  a  fear  of  being  thought  behind 
the  literature  of  their  time. 

The  length  of  a  course  of  lectures  is  not  the 
measure  of  its  value  to  the  student.  A  course 
of  lectures  should  not  outlast  the  curiosity  of 
its  hearers,  nor  their  average  pecuniary  ability 
to  attend.  Custom  in  this  country  has  generally 
fixed  the  limits  of  these  things  at  about  four 
months.  A  comprehensive  and  judicious  course, 
confined  to  the  enforcing  of  necessary  points, 
is  far  more  profitable  than  a  more  discursive 
course  to  a  wearied  and  diminishing  audience. 

Lectures  are  chiefly  wanted  to  impress  by  de- 
monstration the  practical  branches  of  science, 
and  they  are  most  effective  in  places  where  the 
facilities  for  such  demonstrations  can  be  com- 
manded. Anatomy  requires  extensive  exhibi- 
tions by  the  teacher,  and  personal  dissections  by 
the  student.  Chemistry  and  Materia  Medica 
require  illustrations  by  specimens  and  experi- 
ments. Pathology  needs  the  aid  of  autopsies, 
museums  and  the  clinical  demonstrations  of 
large  hospitals.  A  knowledge  of  Obstetrics  is 
not  perfected  without  apparatus  and  practice. 
7 


PRACTICAL    VIEWS 


Surgery  is  acquired  by  witnessing  numerous 
operations,  surgical  diseases,  illustrated  expla- 
nations, and  by  personal  practice  on  the  dead 
body.  Physical  exploration  is  wholly  demon- 
strative. A  knowledge  of  auscultation  can  no 
more  be  acquired  from  books,  or  abstract  lec- 
tures, than  a  knowledge  of  music,  or  of  individ- 
ual physiognomy. 

The  intermediate  period  between  lectures, 
should  be  spent  by  students  in  active  and  origi- 
nal study,  approved  and  confirmed  by  regular 
recitations,  and  by  such  opportunities  as  can  be 
commanded,  for  practical,  personal  experience. 
Private  schools  for  small  classes,  and  the  private 
teaching  of  individuals,  who  are  suitably  quali- 
fied and  situated,  are  more  advantageous  for 
two  thirds  of  the  year,  than  either  the  fatiguing 
jostle  of  overcrowded  rooms,  or  the  listless  rou- 
tine kept  up  by  the  survivors  of  a  passive  class. 

The  usefulness  of  a  medical  school  depends 
not  so  much  on  the  length  of  its  session,  as 
upon  the  amount  of  education,  preliminary  and 
ultimate,  which  it  requires,  the  fidelity  with 
which  it  exacts  its  own  professed  requisitions, 
and  the  train  of  healthy  exertion,  active  inquiry 


ON    MEDICAL    EDUCATION.  99 

and  rigid,  methodical,  self-regulating  study,  to 
which  it  introduces  its  pupils.  The  longest 
lectures  are  of  little  use  to  students  who  want  a 
common  education,  and  whose  medical  educa- 
tion does  not  qualify  them  afterwards  to  observe, 
to  inquire,  and  to  discriminate.  The  exacted 
evidence  of  three  years  of  well-conducted  study, 
is  better  than  the  exhibited  ticket  of  a  six 
months'  course. 

The  subjects  most  important  to  be  well 
taught  in  medical  schools,  are  the  elementary 
principles  which  constitute  the  frame-work  of 
medical  sciences,  and  the  mode  of  thought  and 
inquiry  which  leads  to  just  reasoning  upon 
them.  After  these,  most  attention  should  be 
given  to  selecting  and  enforcing  such  practical 
truths,  as  will  most  certainly  be  wanted  by  the 
young  practitioner,  in  his  future  career  of 
responsibility. 

The  things  to  be  avoided  by  medical  teachers 
are  technicalities,  which  are  unintelligible  to 
beginners,  —  gratuitous  assumptions  and  cita- 
tions of  doubtful  authorities, — prolix  disserta- 
tions on  speculative  topics, —  excessive  minute- 
ness in  regard  to  subjects  which  are  intricate 


100  ON    MEDICAL    EDUCATION. 

and  but  little  used,  and  therefore  destined  to  be 
speedily  forgotten.  To  these  may  be  added 
controversies,  superfluous  personal  eulogiums 
and  criminations,  and  all  self-exaggeration, 
personal  or  local. 


REPORT  ON  HOMffiOTATHY: 

MADE   TO    THE   COUNSELLORS    OF  TI1E   MASSACHUSETTS   MEDICAL 
SOCIETY   IN    FEBBUAEY,    1854. 

THE  committee  appointed  by  the  Counsellor? 
of  the  Massachusetts  Medical  Society,  to  con- 
sider the  resolution  of  the  Essex  North  District 
Society,*  and  also  that  of  Dr.  Spofford,  in  rela- 
tion to  the  subject  of  Homoeopathy,  beg  leave 
to  Report  :  — 

That  the  Massachusetts  Medical  Society  was 
incorporated  mainly  for  the  purpose  of  estab- 
lishing a  proper  standard  of  medical  education, 
and  of  insuring  a  competent  degree  of  knowl- 
edge among  those  who  should  be  authorized  to 
practise  the  profession  of  medicine  in  this  Com- 
monwealth, and  they  are  not  aware  that  the 
Society  possess  any  power  to  coerce  men,  after 

*  These  resolutions  contemplated  dissolving  the  connection  of 
Homceopathists  with  the  Society. 


102  REPORT    ON    HOMOEOPATHY. 

they  have  been  thus  educated  and  qualified,  to 
embrace,  or  renounce,  any  theoretical  opinions, 
or  modes  of  practice,  which  they  may  innocent- 
ly believe,  or  which,  not  believing,  they  may 
think  it  proper  to  profess. 

In  medical  science  there  are  certain  funda- 
mental laws  relating  to  the  structure  and  func- 
tions of  the  body,  and  the  morbid  changes  to 
which  it  is  subject,  also  regarding  the  signs  by 
which  those  changes  are  discovered,  —  upon 
which  all  well-educated  physicians  are  agreed. 
But  in  certain  provinces  of  medical  science 
such  fundamental  laws,  owing  to  the  imperfec- 
tion of  our  means  of  knowledge,  cannot  at  the 
present  time  be  established.  This  is  the  case 
with  Therapeutics,  or  the  art  of  treating  or 
curing  diseases,  in  which  the  evidence  required 
by  science  is  difficult  to  obtain,  and  in  regard  to 
which  writers  and  teachers,  sects  and  individu- 
als, and  even  the  same  individual  in  the  course 
of  an  ordinary  life-time,  may  without  dishon- 
esty entertain  great  diversities  of  opinion. 

The  tendency  of  modern  observation  is  such 
as  to  lead  us  to  the  belief  that  disease  is  less 
frequently  under  the  control  of  remedial  treat- 


REPORT    ON    HOMOEOPATHY.  103 

ment  than  it  was  formerly  supposed  to  be. 
Where  observations  are  impartially  made  by 
competent  persons,  it  is  found  that  people  re- 
cover, and  also  that  they  die,  under  all  the 
ordinary  modes  of  treatment.  And  the  evi- 
dence collected  from  sources  which  are  worthy 
of  reliance,  is  not  so  abundant  or  satisfactory  as 
to  convince  a  reasonable  man  that  any  general 
system  of  practice  can  be  relied  on  for  the  cure 
of  all  cases.  Hence  it  is  not  surprising  that 
diversities,  contrasts,  and  even  extravagances 
in  practice,  are  embraced  by  the  sanguine,  the 
credulous,  the  uninformed  and  the  interested, 
frequently  based  upon  no  better  authority 
than  accident,  imperfect  observation,  or  defec- 
tive power  of  judgment  in  the  party  who  adopts 
them. 

The  broadest  division  which  has  been  recog- 
nized for  centuries  in  the  treatment  of  disease, 
is  that  which  resolves  the  whole  subject  into 
the  active  and  the  expectant  modes  of  practice. 
The  first  employs  various  interfering  agencies 
in  the  management  of  the  sick, — the  last  waits 
more  on  the  unassisted  course  of  nature, —  and 
both  have  long  had  their  exclusive  advocates. 


104  REPORT    ON    HO.MCEOPATHY. 

To  the  last  of  these  divisions  Homoeopathy 
really,  though  not  avowedly  belongs.  Its  char- 
acter is,  that  while  in  reality  it  waits  on  the 
natural  course  of  events,  it  commends  itself  to 
the  ignorant  and  credulous  by  a  professed  intro- 
duction into  the  body  of  inappreciable  quanti- 
ties of  medicinal  substances.  Now  the  nugatory 
effect  of  such  quantities  is  demonstrated  by  the 
fact,  that  in  civilized  life  every  person  is  exposed 
to  the  daily  reception,  in  the  form  of  solution, 
dust  or  vapor,  of  homoeopathic  quantities  of 
almost  every  common  substance  known  in 
nature  and  art,  without  any  appreciable  conse- 
quences being  found  to  follow.  And  the  pre- 
tended exactness  with  which  such  nominal  doses 
are  administered  by  homoeopathic  practitioners, 
is  doubtless  a  fallacy,  capable  of  producing  in 
the  living  body  no  other  effects  than  those  which 
charlatanry  has  in  all  ages  produced  in  the 
minds  and  bodies  of  imaginative  patients. 

It  is  a  fact  much  older  than  the  institution  of 
this  Society,  that  visionary  systems  of  practice 
have  replaced  each  other  in  the  faith  of  multi- 
tudes, at  least  several  times  in  a  century.  And 
this  will  probably  be  the  case,  so  long  as  prac- 


REPORT    ON    HOMOEOPATHY.  105 

tical  medicine  continues  to  be,  what  it  now  is 
to  a  great  extent,  a  theoretical  and  conjectural 
science.  At  the  present  period,  among  the  sects 
usually  called  irregular,  the  homoeopathic  sect 
prevails  to  a  considerable  extent  in  this  country 
and  in  Europe.  In  the  United  States  it  is 
exceeded  only  by  the  sect  called  Botanic,  or 
Thompsonian  practitioners,  which  at  the  present 
time  appears,  of  the  two,  to  number  most  disci- 
ples. It  is  not  probable  that  the  faith  of  either 
of  these  sects  will  be  displaced  by  a  return  of 
their  followers  to  any  more  enlightened  or 
rational  creed.  Nevertheless,  it  is  safe  to  pre- 
dict that  they  will  both  be  superseded  in  the 
course  of  time  by  other  systems,  not  more 
rational  or  probable  in  themselves,  but  possess- 
ing the  attraction  of  greater  novelty,  or  urged 
upon  the  credulous  with  greater  adroitness. 
"When  the  world,  and  especially  the  unen- 
lightened part  of  it,  shall  be  settled  in  their 
opinions  on  other  sectarian  subjects,  we  may 
anticipate  unanimity  of  opinion  among  them  in 
the  science  of  practical  medicine. 

But  it  is  not  only  to  expectant  medicine,  in 
the  form  of  its  counterfeit,  homosopathy,  that 


106  REPORT    ON    HOMOEOPATHY. 

the  censure  of  prejudice  and  credulity  is  to  be 
attached.  The  opposite  system  of  active  prac- 
tice, carried  to  the  extreme  usually  called  heroic, 
is  alike  chargeable  with  evil  to  the  patients, 
whenever  it  becomes  the  absorbing  and  exclu- 
sive course  of  the  practitioner.  Physicians  are 
too  often  led  to  exaggerate  the  usefulness  of  the 
doctrines  in  which  they  have  been  educated, 
and  especially  of  those  by  the  exercise  of  which 
they  obtain  their  daily  bread.  In  such  cases 
habit  gets  the  ascendancy  over  enlightened 
judgment,  and  the  man  of  routine,  or  of  narrow 
views,  asks  himself,  from  day  to  day,  what  drug 
or  what  appliance  he  shall  next  resort  to,  instead 
of  asking  the  more  important  question,  whether 
any  drug  or  any  appliance  is  called  for,  or  is 
properly  admissible  in  the  case. 

In  Medicine,  as  in  the  other  inexact  sciences 
which  deeply  concern  the  welfare  of  mankind, 
enough  has  been  learned  to  show  that  extreme 
measures,  either  of  omission  or  of  commission, 
are  not,  when  systematized  as  a  whole,  produc- 
tive of  benefit  or  safety  to  mankind. 

It  is  quite  probable  that  the  prevalence,  at 
times,  of  eccentric  and  ultra-sectarian  doctrines 


REPORT    ON    HOMOEOPATHY.  107 

in  medicine,  is  attributable  to  the  exaggerated 
value  attached  by  physicians  themselves  to  in- 
cessant activity  in  practice,  and  an  assumption 
of  credit  for  particular  modes  of  medication,  to 
which,  as  such,  they  are  not  entitled.  There  is 
often  a  want  of  openness  in  the  intercourse  of 
physicians,  both  enlightened  and  ignorant,  with 
their  patients,  who  are  requested  to  believe  that 
their  cure  depends  not  in  any  degree  on  the 
salutary  influences  of  nature  and  time,  but  in 
the  rigid  enforcement  of  a  prescribed  routine  of 
practice,  either  active  or  formal,  as  the  case 
may  be.  And  when  opposite  modes  of  treat- 
ment are  urged  upon  the  public  by  different 
practitioners  with  reasonings  equally  specious, 
it  is  not  surprising  that  patients  should  some- 
times adopt  that  which  is  least  troublesome  in 
its  operation.  Neither  is  it  surprising  that  they 
should  sometimes  embrace  even  a  deception, 
which  absolves  them  from  their  allegiance  to  an 
unnecessarily  severe  or  troublesome  course  of 
treatment. 

An  honest  and  independent  practitioner,  and 
especially  a  member  of  the  Massachusetts  Med- 
ical Society,  should  never  be  induced  to  give 


108  REPORT    ON    HOMOEOPATHY. 

his  counsel,  or  his  aid  in  any  shape,  to  empiri- 
cism and  dishonesty,  whether  it  occur  among 
those  who  are  within  or  without  the  pale  of  its 
membership.  And  no  consideration  of  gain  or 
notoriety  should  induce  those,  whose  age  or 
standing  cause  them  to  be  resorted  to  for  'con- 
sultation, to  lend  their  influence  or  countenance 
to  encourage  either  the  delusions  of  those  who 
are  honest,  or  the  practices  of  those  who  are 
not. 

If  quackery,  individual  or  gregarious,  is  ever 
to  be  eradicated,  or  even  abated,  in  civilized 
society,  it  must  be  done  by  enlightening  the 
public  mind  in  regard  to  the  true  powers  of 
medicine.  The  community  must  be  made  to 
understand  that  there  are  certain  things  which 
medicine  can  do,  and  certain  other  things  which 
it  cannot  do ;  that  some  diseases  are  curable  by 
active  interference,  and  others  by  time  and 
nature  alone  ;  that  true  medical  skill  lies  in  dis- 
crimination and  prognosis,  and  judicious  adap- 
tation of  management,  more  than  in  assumed 
therapeutic  power,  in  regard  to  special  agents  ; 
and  that  he  who  professes  to  cure  by  medicine 
a  self-limited  fever,  is  as  much  an  impostor,  or 


REPORT    ON    HOMCEOPATHY.  109 

deluded  man,  as  he  who  pretends  to  do  the  same 
thing  with  a  fractured  bone  or  incised  wound. 
Nothing  so  much  shakes  the  confidence  of  man- 
kind in  the  medical  profession  as  unfulfilled 
promises  ;  nothing  so  much  strengthens  this 
confidence,  as  fair  dealing  exhibited  in  an  earn- 
est requirement  and  fearless  expression  of  the 
truth.  Such  a  course,  by  commending  itself  to 
the  sensible  and  enlightened,  may  be  expected, 
sooner  or  later,  in  some  measure  to  influ- 
ence the  unreasonable  and  ignorant,  —  much 
sooner,  indeed,  than  a  warfare  carried  on  in  the 
arena  of  empiricism  with  its  own  weapons. 


ON  THE  MEDICAL  PROFESSION 
AND  QUACKERY. 


AN   INTRODUCTORY   LECTURE,    DELIVERED    AT    THE    MEDICAL  COL- 
LEGE,  BOSTON,   NOVEMBER   6,    1844. 


I  AM  about  to  address  myself  to  an  audience 
of  young  men,  a  class  of  persons  who,  in  our 
new  and  active  country,  assume  an  influence, 
and  wear  a  responsibility,  unknown  in  the  older 
communities  of  Europe.  The  sparse  character 
of  our  population,  the  call  for  active  and  efficient 
men,  the  sure  market  which  exists  for  talents, 
and  even  for  common  ability  and  prudence, 
have  given  a  national  precocity  to  our  youth, 
and  a  readiness  in  adapting  themselves  to  new 
and  difficult  spheres  of  action.  I  have  heard 
foreigners  speak  with  surprise  of  the  arrival,  in 
distant  ports  of  Europe  or  India,  of  American 
ships  commanded,  not  as  is  usual,  by  weather- 


ON    THE    MEDICAL    PROFESSION.  Ill 

beaten  veterans,  but  by  beardless  striplings. 
The  signs  of  our  mercantile  houses  bear  often 
the  names  of  very  young  men,  and  the  avenues 
of  our  professions  are  so  crowded  with  them, 
that  perhaps  no  regulation  is  more  liable  to  be 
infringed  than  that  which  requires  that  profes- 
sional candidates  shall  be  twenty-one  years  of 
age.  Young  men  command  the  ranks  of  our 
military  corps  and  swell  our  political  meetings. 
Their  voice  is  heard  among  us  in  the  periodical 
press  and  in  the  halls  of  legislation. 

These  precocious  habits  of  our  country  have 
of  course  been  felt  in  the  medical  profession.  In 
most  of  the  schools  of  Europe,  medical  honors 
are  not  conferred  until  after  a  novitiate  of  four, 
and  more  frequently  five  years,  during  which  an 
extensive  circle  of  sciences  is  obliged  to  be 
mastered,  and  to  be  approved  by  a  series  of 
strict  examinations.  Not  only  are  the  essential 
branches  of  medicine  required  to  be  fully  under- 
stood, but  they  must  be  preceded  by  a  knowl- 
edge of  the  subsidiary  sciences,  and  must  also 
be  confirmed  by  practical  and  clinical  expe- 
rience. 

With  us,  on  the  other  hand,  the  short  period 


112  ON    THE    MEDICAL 

of  three  preparatory  years  devoted  to  regular 
study  and  lectures,  may  be  said  to  constitute 
nearly  the  sum  total  of  a  medical  education ; 
for  the  collateral  requirements  are  so  small  that 
their  acquisition  is  often  effected  during  the 
same  three  years  which  are  applied  to  the  other 
branches.  And  a  young  man  who  has  learned 
to  read  and  write,  issues  from  the  village  school 
or  perhaps  from  the  counter  or  the  plough,  and 
in  three  years  is  licensed,  and  declared  compe- 
tent to  exercise  the  multifarious  profession  of 
medicine  and  surgery  in  all  its  departments. 
As  it  often  happens  in  this  and  similar  casesr 
the  newly-approved  candidate  sends  forth  his 
anxious  glance,  directed  not  always  to  his  own 
deficiencies  or  the  means  of  supplying  them,  but 
to  that  common  goal  and  object  of  a  young 
man's  inquiry,  which  is  to  fill  up  the  measure  of 
his  practical  aspirations  —  an  opening.  By  the 
timely  decease  of  some  elderly  practitioner,  or 
by  the  fortunate  discovery  of  a  rising  settlement, 
in  some  distant  State,  or  on  some  promising 
water-power,  he  finds  himself,  perhaps  at  short 
notice,  installed,  under  virtue  of  the  acquiescent 
silence  of  the  small  community  in  which  he 


PROFESSION.  113 

lives,  the  constituted  physician  of  the  place.  In 
one  month,  perhaps  in  one  week,  he .  may  be 
called  upon  to  diagnosticate  organic  lesion  in  a 
case  of  life  and  death,  or  to  treat  the  most  for- 
midable convulsive  disease.  He  may  be  sum- 
moned to  tie  the  femoral  artery,  or  to  decide  and 
act  in  a  case  of  placental  presentation.  There 
may  be  no  consulting  physician  within  many 
miles,  at  least  none  who  can  arrive  in  season 
for  the  emergency. 

The  safety  then,  and  probably  the  lives  of  the 
unfortunate  constituents  of  this  young  man, 
will  depend  upon  the  question  whether  he  has, 
or  has  not  been  truly  educated,  whether  his 
mind  and  hand  have  been  adequately  trained 
for  the  great  occasions  that  await  him.  It  is 
not  enough  that  he  has  suffered  three  years  to 
expire  while  taking  his  ease  in  the  office  of  a 
city  physician,  nor  that  he  has  passed  a  corres- 
ponding time  in  following  the  rounds  of  a  coun- 
try practitioner.  It  is  not  enough  that  he  has 
carelessly  read  the  works  of  approved  authors, 
and  has  squeezed  through  the  customary  aca- 
demic examination.  If  he  has  done  only  this, 
it  is  more  than  probable  that  failure  awaits  on 


114  ON    THE    MEDICAL 

himself  and  disaster  upon  his  patient.  But  if 
his  studies  have  been  methodical,  and  conducted 
with  an  eye  to  practical  application  ;  if  he  has 
concentrated  his  attention  upon  necessary 
points  ;  if  he  has  felt  the  earnest  interest  which, 
more  than  anything  else,  imprints  truth  on  the 
remembrance ;  if  he  has  gathered  up  and  ar- 
ranged his  resources  in  reference  to  coming 
emergencies  ;  if  he  has  gone  over  in  anticipation 
the  difficulties  of  his  profession,  and  planned  his 
own  mode  of  extrication, — then  he  will  find 
that  inexperience  does  not  involve  failure,  and 
that  youth  is  not  an  insurmountable  barrier  to 
success.  He  will  recollect  that  the  most  emi- 
nent physicians  and  the  most  successful  opera- 
tors have  had  their  first  cases.  He  will  perhaps 
also  remember,  that  some  of  the  most  distin- 
guished men  in  history  have  emerged  from 
obscurity  while  yet  in  youth ;  that  not  only 
warriors,  like  Alexander  and  Napoleon,  but 
statesmen,  like  Pitt  and  Fox,  and  philosophers, 
like  Davy  and  Bichat,  had  achieved  some  of 
their  proudest  laurels  at  the  very  entrance  of 
manhood. 

Let  it  not  be  supposed,  however,  that  I  am 


PROFESSION.  115 

an  advocate  for  the  premature  assumption,  by 
young  men,  of  the  responsibilities  of  our  profes- 
sion. Every  medical  student  is  to  be  considered 
unfortunate,  who  by  reason  of  poverty,  or  the 
stress  of  other  circumstances,  is  obliged  to  hurry 
his  probationary  period  to  an  early  termination. 
Too  much  time  and  attention  are  not  often 
bestowed  on  the  business  of  preparation  for 
practice.  The  oldest  and  the  best  physicians 
have  had  frequent  cause  to  regret  that  they 
were  not  better  educated.  But  the  superficial 
student,  who  rarely  has  the  time  and  the  will  to 
repair  his  early  deficiencies,  is  haunted  through 
life  by  a  round  of  perplexity  and  embarrass- 
ment,  and  degraded  by  a  sense  of  his  own 
incompetency. 

It  should  be  borne  in  mind,  that  there  is  no 
period  of  life  in  which  time  can  be  so  conve- 
niently spared  from  lucrative  pursuits,  as  in 
youth.  After  a  man  has  atained  to  the  age  of 
thirty,  it  is  commonly  of  very  little  consequence 
to  him,  as  far  as  his  fame  and  yearly  receipts 
are  concerned,  whether  he  had  commenced  prac- 
tice at  the  age  of  twenty-one  or  of  twenty -four. 
But  as  far  as  he  may  prize  a  quiet  conscience 


116  ON    THE    MEDICAL 

and  freedom  from  anxiety,  the  later  age  is  in- 
comparable the  most  secure.  I  would  advise 
any  young  man,  who  has  completed  his  educa- 
tion at  the  end  of  his  minority,  that  he  should 
devote  two  additional  years,  and  if  practicable, 
a  still  longer  period,  to  availing  himself  of  such 
advantages,  both  in  study  and  practice,  as  may 
prepare  him  for  his  future  duties.  And  when, 
as  it  often  happens  in  our  community,  narrow 
circumstances  require  that  a  young  man  should 
live  by  his  own  exertions,  this  state  of  things, 
instead  of  being  a  motive  that  he  should  crowd 
himself  prematurely  into  the  ranks  of  the  pro- 
fession, encumbered  with  debt,  and  bare  of 
acquirements  and  of  means,  is  rather  an  imper- 
ative reason  that  he  should  at  once  begin  by 
resolving  to  devote  twice  the  customary  number 
of  years,  if  necessary,  to  the  double  purpose  of 
keeping  himself  in  an  independent  position,  and 
of  placing  himself  at  length,  in  point  of  maturity 
of  knowledge,  on  a  par  with  his  more  favored 
competitors. 

It  may  not  be  improper,  in  this  place,  to  offer 
you  some  suggestions  as  to  the  mode  in  which 
students  may  advantageously  appropriate  the 


PROFESSION.  117 

time  of  their  pupilage  in  reference  to  the  science 
which  they  expect  to  acquire.  Medical  litera- 
ture has  become  so  vast  a  subject,  that  the 
undirected  student  is  apt  to  be  lost  in  the  maze 
of  books  and  sciences  which  seem  equally  to 
press  upon  his  attention.  And  he  is  likely  to 
fall  into  the  pernicious  error  of  thinking  that  he 
must  read  a  great  deal,  even  though  he  remem- 
bers little.  The  true  object  of  a  medical 
pupilage  should  be,  not  to  read,  but  to  study, 
to  observe,  and  to  remember ;  not  to  pass 
superficially  over  the  writings  of  celebrated 
men,  but  to  select  those  compendiurns  of  the 
several  sciences,  which  contain  a  condensed 
view  of  their  essential  and  elementary  facts, 
which  separate  the  wheat  from  the  chaff,  and 
offer  what  is  fundamental  and  useful,  within  a 
compass  which  is  capable  of  being  impressed  on 
the  memory.  Most  of  the  constituent  sciences 
which  are  nominally  included  in  a  modern  med- 
ical education,  are  now  so  extensive,  that  the 
cultivation  of  any  one  of  them  may  afford 
abundant  occupation  for  a  common  lifetime. 
Passing  over  the  more  elementary  branches,  I 
may  instance  the  theory  and  practice  of  medi- 


118  ON    THE    MEDICAL 

cine,  the  literature  of  which  is  a  vast  magazine 
of  rubbish,  with  a  few  gems  imbedded  in  it, 
accumulated  in  all  time  since  the  origin  of 
writing,  and  in  such  excess  that  no  country  in 
Europe  could  probably  furnish  even  a  catalogue 
of  its  own  modern  books.  The  history  of  this 
extensive  science  contains  a  mixture  of  much 
that  is  bad,  with  much  less  that  is  good.  And 
although  in  medical  research  the  still  small 
voice  of  truth  has  from  time  to  time  made  itself 
heard  for  a  season,  yet  it  has  as  often  been 
drowned  by  the  dogmas  of  the  visionary  and 
the  clamors  of  the  interested.  During  the  pres- 
ent century  a  host  of  theorists  and  gratuitous 
reformers  have  replaced  each  other  on  the  arena 
of  medical  controversy.  But  we  have  seen  that 
while  a  truth  in  medical  science,  like  the  import 
of  the  physical  signs  for  example,  struggles  its 
way  through  opposition  and  distrust  into  gene- 
ral adoption,  —  an  unfair  and  unfounded  as- 
sumption rarely  survives,  long  the  life  of  the 
individual  whose  own  eloquence  and  obstinacy 
were  necessary  to  force  it  for  a  time  upon  the 
public  attention. 

If  we  could  purge  the  sciences  of  pathology 


PROFESSION.  119 

and  therapeutics  from  the  writings  of  men  who 
wrote  merely  because  they  had  a  reputation  to 
acquire  or  a  doctrine  to  establish ;  and  could 
confine  these  sciences  to  the  results  attained  by 
those  who  sought  directly  and  impartially  for 
the  true  and  the  useful ;  it  is  probable  that  the 
whole  subject  would  be  brought  within  the 
comprehension,  not  only  of  every  physician,  but 
of  every  medical  student  And  from  the  recent 
mode  of  conducting  medical  investigations, 
which  has  commenced  and  is  gradually  gaining 
foothold  in  all  civilized  countries,  we  may  hope, 
in  our  own  day,  to  see  near  approaches  to  this 
desirable  result. 

Every  medical  man,  whether  student  or  phy- 
sician, owes  a  threefold  duty,  to  himself,  to  his 
competitors,  and  to  his  patients.  To  himself 
he  owes  the  cultivation  of  habits  of  order  and 
perseverance,  a  love  of  honesty  and  a  desire  of 
knowledge.  No  man  is  successful  in  a  learned 
profession,  who  does  not  cultivate  a  methodical 
disposition  of  his  time.  The  neglect  of  an  hour, 
the  omission  of  an  engagement,  and  the  post- 
ponement of  what  is  necessary  for  what  is 
unimportant,  have  ruined  many  a  good  inten- 


120  ON    THE    MEDICAL 

tion  and  many  a  promising  prospect.  Lord 
Chesterfield  says,  that  the  Duke  of  Newcastle 
lost  half  an  hour  in  the  morning,  and  spent  the 
whole  day  in  running  after  it.  This  is  a  true 
expression  of  the  career  of  a  busy  but  inefficient 
man.  He  who  is  always  driven,  always  in  a 
hurry,  always  late,  and  always  with  deficiencies 
to  be  made  up,  is  very  likely  to  be  always  a 
failure.  It  is  well  known  that  the  responsi- 
bilities of  society  are  best  and  most  easily 
discharged  by  those  who  estimate  the  value  of 
small  portions  of  time,  who  do  things  strictly 
in  their  proper  season  and  place,  who  provide 
against  contingencies,  and  distribute  their  day 
in  reference  to  what  is,  as  well  as  to  what  may 
be  required  of  them. 

But  the  best  ordered  arrangement  of  time, 
and  the  most  punctual  habits  of  attention,  do 
not  always  succeed  in  our  profession,  except 
through  perseverance,  and  often  through  long 
suffering.  The  public,  especially  in  cities,  are 
slow  in  giving  their  confidence  to  strangers  and 
to  young  men.  The  late  Dr.  Physick,  of  Phila- 
delphia, asserted  that  during  the  first  three 
years  of  his  practice  he  did  not  pay  for  his  shoe 


PROFESSION.  121 

leather;  and  a  late  very  eminent  physician  of 
this  city  once  informed  me,  that  he  did  not 
earn  his  own  board  during  three  times  that 
period.  The  conservative  principle  which  retards 
the  reception  of  young  men  into  lucrative  busi- 
ness, is  the  foundation  of  their  security  in  after 
life,  for  medical  practice  would  not  be  worth 
having,  in  a  community  whose  love  of  change 
should  lead  them  to  desert  their  former  friends 
and  counsellors,  to  run  after  every  new  comer. 
Physicians  usually  come  on  to  the  stage  and 
move  off  of  it,  in  company  with  the  generation 
to  which  they  belong.  In  a  large  city,  a  young 
physician,  except  under  circumstances  of  pecu- 
liar patronage  or  necessity,  does  not  usually  ob- 
tain employment  from  families  who  are  much  in 
advance  of  himself.  But  these  families  and  their 
medical  attendants  pass  away,  and  he  and  his 
cotemporaries  become  the  standing  practitioners 
of  their  time.  A  preparatory  period  in  the  mean 
time  elapses,  during  which  the  candidate  for 
future  honors  has  usually  enough  to  do,  to  per- 
fect his  knowledge,  to  fill  the  gaps  in  his  expe- 
rience, and  to  give  proofs  to  the  community 


122  ON    THE    MEDICAL 

around  him,  that  he  possesses  aptitude  for  the 
common  affairs  of  life. 

Every  physician  is  an  inquirer  during  life, 
and  continues  to  learn  something  up  to  the  last 
year  in  which  he  may  happen  to  study  or  prac- 
tise. As  the  science  advances,  moreover,  every 
intelligent  practitioner  is  obliged  to  replace  some 
of  his  former  opinions  with  others,  which  he 
finds  to  be  better  substantiated.  We  should  be 
careful,  therefore,  not  to  pledge  ourselves  unne- 
cessarily to  medical  opinions  which  are  founded 
on  equivocal  or  imperfect  testimony.  The  pub- 
lic sentiment  attaches  a  kind  of  disgrace  to 
frequent  changes  and  recantations,  and  they 
ought  also  to  do  the  same  to  the  course  of  any 
man,  who -for  the  sake  of  consistency  with  him- 
self, continues  to  maintain  an  erroneous  and 
exploded  opinion.  Both  these  extremes  are 
avoided  by  the  physician  who  reserves  his  assent 
to  any  new  opinion,  until  the  evidence  of  the 
case  is  satisfactorily  made  out. 

One  of  the  most  difficult  virtues  for  a  physi- 
cian to  cultivate,  is  a  just  and  proper  deportment 
towards  his  professional  brethren.  As  in  all  pro- 
fessions in  which  men  live  by  their  heads  rather 


PROFESSION.  123 

than  their  hands,  business  is  liable  to  be  over- 
done, and  a  candidate  who  has  not  acquired  all 
the  occupation  that  he  wishes,  is  apt  to  regard 
his  competitors  as  stumbling-blocks,  to  be  gotten 
rid  of  by  fair  means,  or  foul.  Hence  arise  the 
jealousies,  calumnies,  and  open  hostilities  so 
often  entertained,  which  injure  all  the  parties 
concerned,  and  lower  the  estimation  of  the  pro- 
fession with  the  public.  Harmony  and  a  proper 
esprit  du  corps,  may  uphold  the  dignity  of  even 
an  inferior  profession  ;  but  the  public  rarely  re- 
spect any  class  of  men,  the  members  of  which 
have  no  respect  for  each  other.  A  friendly  in- 
tercourse with  those  whom  we  approve,  is  pro- 
ductive of  pleasure  and  advantage,  and  a  gen- 
tlemanly forbearance  towards  those  with  whom 
we  do  not  agree,  will  show  that  we  are  above 
jealousy.  A  man  is  always  to  be  suspected, 
who  tells  you  that  he  is  surrounded  with  ene- 
mies ;  and  one  who  is  an  habitual  calumniator 
of  others,  forces  upon  his  hearers  the  conviction 
that  they  in  their  proper  turn  are  to  come  in  for 
their  share  of  his  animadversions. 

I  doubt  if  physicians  do  not  sometimes  injure 
themselves   and  their   cause,   by   showing  too 


124  QUACKERY. 

great  a  sensitiveness  in  regard  to  the  temporary 
inroads  of  irregular  practitioners.  Quackery 
whether  carried  on  by  the  audacious  enterprise 
of  an  individual  impostor,  or  upheld  by  the 
trumpeting  of  a  fanatical  sect,  is  to  be  consider- 
ed a  necessary  evil  inherent  in  the  constitution 
of  society.  It  exists  in  every  walk  and  occupa- 
tion of  life,  by  the  exercise  of  which  men  pro- 
cure bread.  The  pettifogger  in  law,  the  Millerite 
lecturer  in  theology,  the  demagogue  in  politics, 
the  system-monger  in  education,  and  the  won- 
der-worker upon  the  brains  and  bowels  of  infat- 
uated audiences  —  what  are  all  these  but  quacks 
moving  in  their  respective  spheres,  and  fattening 
upon  the  credulity  of  dupes.  A  certain  portion 
of  mankind  are  so  constituted  that  they  require 
to  be  ridden  by  others,  and  if  you  should  suc- 
ceed in  unhorsing  a  particular  impostor,  it  is 
only  to  prepare  the  saddle  for  a  fresh  and  more 
unflinching  equestrian.  It  is  not  good  policy  to 
say  or  to  write  too  much  in  regard  to  the  pre- 
tensions of  impostors.  A  celebrated  author  ob- 
serves that  'many  a  popular  error  has  flourished 
through  the  opposition  of  the  learned.'  *  By 

*  Mclntosh. 


QUACKERY.  125 

throwing  the  gauntlet  at  an  insignificant  man, 
you  at  once  raise  him  to  the  dignity  of  being 
your  competitor,  and  acknowledge  him  as  a 
'  foeman  worthy  of  your  steel.'  And  if  you  dis- 
cover uneasiness,  resentment,  or  ill  temper,  the 
public  conclude  that  you  are  influenced  by  your 
private  interests.  Besides,  when  you  have  en- 
tered the  arena  of  controversy,  you  will  probably 
find  that  the  quack,  who  has  his  all  at  stake, 
can  afford  more  breath  and  time  than  you  can 
conveniently  spare  from  your  other  occupations, 
and  in  an  active  warfare,  he  may  acquire  two 
partisans  to  your  one.  It  is  not  long  since  the 
exhibiter  of  a  stuffed  mermaid  succeeded  in 
drawing  down  the  popular  indignation  on  an 
unfortunate  naturalist,  who  had  ventured  to 
declare  that  it  was  made  of  a  fish  and  a  monkey. 
The  public  generally  require  time  to  get  dis- 
abused of  a  favorite  error ;  and  if  too  abruptly 
assailed,  they  will  sometimes  hold  on  to  it,  as 
the  traveller  did  to  his  cloak  when  attacked  by 
the  north  wind. 

In  your  demeanor  in  regard  to  quacks,  you 
should  keep  aloof  from  them,  and  trouble  your- 
selves little  about  them.  Admit  the  general 


126  QUACKERY. 

fact  that  the  race  always  do,  and  must  exist  in 
society ;  that  they  are  wanted  by  the  credulity 
of  a  particular  class  of  minds ;  that  the  fall  of 
one  dishonest  pretender,  or  one  visionary  sect, 
is  sure  to  be  replaced  by  the  elevation  of  an- 
other ;  therefore  it  little  concerns  you  to  know 
what  particular  imposition  has  the  ascendency 
at  any  given  time.  When  you  are  interrogated 
in  regard  to  a  specific  subject  of  this  kind,  you 
should  make  a  reasonable,  cogent,  and  dispas- 
sionate answer,  always  avoiding  the  appearance 
of  warmth  and  especially  of  self-interest;  and 
you  may  be  sure  that  a  majority  of  the  public 
will  be  on  the  side  of  truth.  As  far  as  my  ob- 
servation extends,  three  quarters  at  least  of  the 
families  in  Boston  and  New  England,  are  in  the 
hands  of  regular  practitioners.  The  remaining 
fraction,  more  or  less,  consists  partly  of  minds 
so  constituted  that  they  require  the  marvellous 
as  a  portion  of  their  necessary  food,  and  partly 
of  unfortunate  beings,  suffering  the  inevitable 
lot  of  humanity,  who  having  failed  to  obtain 
relief  from  the  ordinary  resources  of  medicine, 
seek  for  temporary  encouragement  in  the  dishon- 
est assurances  of  any  who  will  promise  to  cure 


QUACKERY.  127 

them.  The  first  class  is  the  dog  in  the  fable, 
catching  at  shadows ;  the  last  is  the  drowning 
man  catching  at  straws. 

Above  all,  if  you  would  discountenance 
quackery,  take  care  that  you  become  not  quacks 
yourselves.  Charlatanism  consists  not  so  much 
in  ignorance,  as  in  dishonesty  and  deception. 
In  your  intercourse  with  patients,  cultivate  a 
spirit  of  fidelity,  candor  and  truth.  Endeavor 
to  understand  yourselves  and  your  science, 
weigh  justly  your  own  powers,  and  profess  only 
what  you  can  accomplish.  If  you  announce  to 
your  patients  that  you  will  cure  incurable  dis- 
eases, or  cut  short  those  which  have  a  necessary 
period  of  duration,  you  do  not  speak  the  truth, 
you  merely  blind  your  patient,  while  you  throw 
the  die  for  a  fortuitous  result,  a  game  at  which 
the  veriest  mountebank  may  at  any  time  beat 
you.  The  profession  as  a  body  are  often  unpo- 
pular with  a  large  and  sagacious  part  of  the 
community,  because  they  so  frequently  disap- 
point the  expectations  they  have  allowed  them- 
selves to  raise.  You  may  safely  undertake  and 
promise  to  cure  diseases  which  you  know  to  be 
curable,  to  alleviate  others  which  you  know  to 


128  ON    THE    MEDICAL 

be  not  so,  and  to  perform  what  art  and  science 
can  do  towards  conducting  doubtful  and  dan- 
gerous cases  to  a  happy  issue.  But  this  is  all 
you  can  accomplish  or  promise.  The  skilful 
mariner  may  steer  his  ship  through  a  dangerous 
navigation,  but  he  cannot  control  the  wind  nor 
arrest  the  storm.  Nor  would  he  gain  reputation 
by  professing  to  do  so. 

It  is  hardly  necessary  that  I  should  counsel 
you  not  to  neglect  your  patients,  when  you 
can  do  anything  for  their  welfare  and  security. 
Neglect  of  outward  attentions  is  not,  I  think,  a 
very  frequent  sin  of  physicians,  inasmuch  as 
their  interest  very  obviously  lies  in  a  different 
course.  But  many  practitioners  fall  into  the 
opposite  error  of  over-attention  to  their  patients, 
of  making  them  long,  tedious  or  superfluous 
visits,  of  hampering  them  with  strict  and  com- 
plicated instructions,  and  especially  of  over- 
drugging  them  with  remedies.  There  are  some 
patients,  it  is  true,  who  like  to  be  bled,  blistered 
and  physicked  ;  but  the  number  is  small,  and  in 
most  cases  both  the  instinct  of  the  child,  and 
the  discretion  of  the  grown  man,  cause  them  to 
revolt  against  nauseous  and  painful  inflictions. 


PROFESSION.  129 

When,  therefore,  you  are  called  to  take  charge 
of  a  case,  ask  yourselves  how  great  is  the  dan- 
ger, and  what  is  the  probable  tendency  of  the 
disease,  if  left  to  itself.  If  life  is  in  question, 
and  you  have  reason  to  believe  that  the  patient 
may  be  rescued  by  prompt  and  energetic  reme- 
dies, you  should  not  hesitate  to  employ  them. 
But  in  common,  trivial  and  safe  cases,  such  as 
afford  a  large  part  of  a  physician's  occupation, 
you  should  not  allow  a  habit,  or  a  hobby,  to 
lead  you  into  the  blind  routine  of  always  think- 
ing that  you  must  make  your  patients  worse 
before  they  can  be  better.  I  believe  that  much 
of  the  medical  imposition  of  the  present  day  is 
sustained  in  places  where  practice  has  previously 
been  over-heroic,  and  because  mankind  are  grat- 
ified to  find  that  they  and  their  families  can  get 
well  without  the  lancet,  the  vomit  and  the  blis- 
ter, indiscriminately  applied;  and  because  the 
adroit  charlatan  transfers  the  salutary  influences 
of  time  and  nature,  to  the  credit  of  his  own  less 
disagreeable  inflictions. 

It  is  the  duty  of  physicians  to  elevate  their 
profession,  by  maintaining  in  their  individual 
character  a  high  moral  rectitude,   a  just   and 
9 


130 


ON    THE    MEDICAL 


honorable  conduct,  a  devotedness  to  the  welfare 
of  their  patients,  and  an  unceasing  effort  to 
improve  themselves  and  their  science.  If  this 
course  is  pursued  by  medical  men,  they  can 
hardly  fail  of  becoming  useful  and  respected 
members  of  society.  There  is  no  country  in  the 
world  in  which  the  avenues  to  respectability 
and  distinction,  to  competency,  and  even  to 
wealth,  are  more  open  to  physicians,  than  in  the 
United  States.  It  has  been  observed  that  in 
England,  no  medical  man  is  ever  permitted  to 
attain  the  aristocratic  rank,  which  belongs  to 
birth,  and  which  is  occasionally  accorded  to 
eminence  in  the  military,  political,  legal  and 
financial  professions.  But  in  our  country  there 
is  no  post  of  honor  or  emolument,  and  no  situa- 
tion of  influence  and  distinction,  which  our  his- 
tory does  not  show  to  be  within  the  reach  of 
our  profession.  But  it  is  not  to  political,  or 
extra  professional  preferment,  that  the  true  phy- 
sician should  look.  He  should  rather  be  con- 
tented to  build  up  his  own  character  within  his 
own  sphere,  as  a  man  of  knowledge,  fidelity 
and  honor.  The  respect  of  the  community,  and 
the  attachment  of  friends,  will  always  attend  on 


PROFESSION.  131 

him  who  loves  truth  for  its  own  sake,  pursues 
knowledge  that  he  may  be  able  to  benefit 
others,  and  deals  justly  with  his  fellow-men, 
consenting  that  they,  in  turn,  should  deal  justly 
with  him. 


GOUT  AND   ITS  TREATMENT 


GOUT,  technically  known  by  the  names  of 
Arthritis  and  Podagra,  is  a  painful,  inflamma- 
tory disease,  appearing  by  paroxysms,  affecting 
chiefly  the  smaller  joints,  but  liable  to  change 
its  seat  to  various  more  important  organs.  It 
is  hereditary  in  its  character,  and  affects  the 
luxurious  more  than  the  laboring  and  abstemi- 
ous classes.  It  seldom  occurs  in  children,  but 
makes  its  appearance  most  commonly  in  middle 
or  advanced  life,  and  affects  men  more  frequent- 
ly than  women. 

The  most  common  place  for  the  primary  at- 
tack of  gout  is  in  the  first  joint,  or  ball,  of  the 
great  toe  of  one  foot.  The  patient,  in  many 
cases  without  previous  indications  of  illness,  is 
surprised  at  being  awakened  in  the  middle  of 


ON    GOUT.  133 

the  night,  or  a  little  later,  by  intolerable  pain  in 
that  joint,  with  much  febrile  heat  and  restless- 
ness, commencing,  perhaps,  in  a  slight  chill. 
The  toe-joint  soon  becomes  swollen,  tense  and 
red.  Sometimes  the  ankle,  heel,  or  instep  is 
similarly  affected.  There  is  exquisite  tender- 
ness on  the  slightest  pressure,  or  motion  of  the 
part.  This  state  of  things  continues  from  six  to 
twenty-four  hours,  after  which  a  remission  of 
pain  takes  place,  with  gentle  perspiration,  and 
tendency  to  sleep.  The  inflamed  joint,  however, 
continues  to  increase  in  swelling,  and  at  length 
becomes  cedematous  and  shining.  On  the  fol- 
lowing night  the  pain  and  fever  return,  and  so 
continue  to  do  for  a  week,  more  or  less,  during 
which  there  is  thirst,  want  of  appetite,  costive- 
ness,  and  scanty  high-colored  urine  depositing 
a  red  or  lateritious  sediment  on  cooling. 

The  paroxysm  lasts  ordinarily  from  three  to 
ten  days,  at  the  end  of  which  time  the  pain  sud- 
denly terminates,  as  if  by  magic.  The  joint 
continues  swollen  and  osdematous  for  a  few 
days,  with  itching  and  exfoliation  of  the  cuticle, 
but  the  patient  returns  to  his  accustomed  health 


134  ON    GOUT. 

with  perhaps  an  unwonted  degree  of  vigor  and 
alacrity. 

A  precursory  stage  in  most  persons  takes 
place  in  advance  of  the  paroxysm.  It  is  mark- 
ed by  a  deranged  state  of  the  appetite  and 
digestion,  by  heartburn,  nausea,  flatulence,  and 
offensive  alvine  discharges,  also  by  languor, 
headache,  low  spirits  and  disturbed  sleep. 

The  first  paroxysm  of  gout  is  the  almost  cer- 
tain prelude  to  others,  which  are  to  follow  after 
an  interval  of  some  months  or  years,  according 
to  the  predisposition  and  habits  of  life  of  the 
patient.  Some  persons  escape  with  two  or 
three  paroxysms  only  during  life  ;  others  have 
an  annual  visitation,  and  others  are  attacked 
once  in  two  or  three  months.  The  frequency  of 
the  paroxysms  goes  on  increasing,  until  in  some 
patients  there  is  hardly  any  respite,  unless  for  a 
few  months  in  summer.  The  later  paroxysms, 
however,  are  often  more  supportable,  but  the 
general  health  is  more  impaired  than  in  the 
earlier  attacks. 

In  the  later  attacks  both  feet  are  liable  to  be 
affected  in  succession,  and  the  inflammation, 
after  having  left  one  foot  may  return  to  it  again. 


ON    GOUT.  135 

The  small  joints  of  the  hand  are  also  subject  to 
the  invasion,  constituting  the  variety  of  gout 
called  chirag-ra.  In  inveterate  cases,  there  is 
scarcely  any  joint  of  the  body  which  may  not 
participate  in  the  extension  of  the  disease. 
Effusion  generally  takes  place  into  the  synovial 
cavities,  and  adjacent  cellular  tissues. 

When  the  disease  has  become  thus  confirmed, 
it  is  usually  called  chronic  gout.  This  common- 
ly follows  the  acute  form,  but  in  some  cases 
may  become  gradually  established  without  it. 
In  chronic  gout  the  affected  limbs  are  disabled 
for  exercise,  they  become  painful  at  night,  in- 
terrupting sleep,  and  are  moved  by  the  patient 
with  difficulty  and  caution.  There  is  also  a 
general  deterioration  in  the  strength  and  spirits, 
the  patient  looks  worn,  sallow  and  haggard,  the 
digestive  powers  are  deranged,  and  there  is 
often  palpitation  and  dyspnrea. 

When  the  disease  has  existed  for  a  certain 
length  of  time,  there  appears  in  some  persons, 
but  not  in  all,  a  deposit  of  calcareous  concre- 
tions, known  by  the  name  of  chalk  stones,  situ- 
ated mostly  in  the  cellular  tissue,  between  the 
outside  of  the  joint  and  the  skin.  Sometimes, 


136  ON    GOUT. 

however,  they  penetrate  the  fibrous  textures  and 
the  cavities  of  the  joints.  These  concretions 
are  fluid,  or  semifluid,  when  first  effused,  but 
become  gradually  solid  by  the  absorption  of 
their  fluid  parts.  They  finally  become  hard 
and  friable,  resembling  common  chalk  in  their 
appearance.  In  their  more  fluid  state  they  are 
formed  of  hydrated  lithate  of  soda,  but  the 
solid  concretions  consist  mainly  of  lithate  of 
soda,  with  some  phosphate  of  lime. 

The  chalky  concretions  are  liable  to  grow 
with  the  return  of  every  paroxysm.  In  bad 
cases  the  skin  finally  gives  way,  and  a  chalky 
serous  fluid  is  discharged.  This  is  afterwards 
replaced  by  a  kind  of  chalky  pus,  and  in  this 
manner  a  part  of  the  chalk  escapes,  but  never 
the  whole,  owing  to  its  entanglement  in  the 
cells  and  textures.  Persons  have  been  known 
to  write  their  names  with  the  denuded  chalk 
protruding  from  the  knuckles.  Sometimes  the 
apertures  close  over  and  cicatrize,  but  are  liable 
to  break  out  again  during  subsequent  parox- 
ysms. Chalk  stones  are  most  common  in  the 
joints  of  the  hands  and  feet,  which  they  distort 
in  an  unsightly  manner.  They  may,  however, 


ON    GOUT.  137 

appear  in  any  part  which  happens  to  be  the 
seat  of  gouty  inflammation. 

Persons  who  are  subjects  of  gout  are  also 
liable  to  gravelly  complaints,  and  to  calculus 
both  of  the  kidneys  and  bladder.  The  urine  is 
found  not  only  to  contain  urea  and  the  other 
solids  in  excess,  but  deposits  lithic  acid  and 
lithate  of  soda.  The  nephritic  complaints  gene- 
rally supervene  after  the  gout  has  lasted  some 
time,  and  the  paroxysms  of  the  two  complaints 
rather  alternate  than  coincide  with  each  other. 

In  regard  to  the  causes  of  gout,  it  is,  in  the 
first  place,  an  hereditary  disease.  A  majority 
of  persons  affected  with  it  can  trace  the  predis- 
position to  their  parents  or  ancestry.  It  does 
not  follow,  however,  that  ail  the  children  of 
gouty  progenitors  have  the  disease.  It  some- 
times leaps  over  one  generation  and  appears  in 
the  next,  and  it  is  frequently  kept  off  in  those 
who  are  disposed  to  it,  by  an  active  and  abste- 
mious life.  When  gout  and  gravel  affect  the 
same  person,  it  often  happens  that  some  of  the 
children  inherit  the  one,  and  some  the  other 
disease,  alone. 

Gout  rarely  if  ever  appears  before  puberty. 


138 


ON    GOUT. 


In  the  statistical  accounts  collected  by  Sir  C. 
Scudamore,  it  appears  that  the  greatest  number 
of  first  attacks  came  on  between  the  ages  of 
thirty  and  forty.  But  although  the  number 
which  begun  in  persons  above  forty  was  some- 
what smaller,  it  is  evident  that  if  averaged  upon 
the  whole  number  of  persons  actually  living, 
above  that  age,  the  proportion  would  be  greater. 

Gout  occurs  more  frequently  in  men,  than  in 
the  female  sex.  Yet  women  are  by  no  means 
exempt  from  it,  and  in  them  it  is  most  apt  to 
appear  after  the  cessation  of  the  catamenia. 
The  stout  and  corpulent,  of  both  sexes,  are 
more  liable  to  it,  than  those  of  the  opposite 
conformation. 

The  cause  which  is  undoubtedly  most  active 
in  the  production  of  gout  is  a  luxurious  life, 
with  the  free  use  of  vinous  liquors.  Persons 
who  take  little  exercise,  and  indulge  largely  in 
the  pleasures  of  the  table,  especially  in  animal 
food  and  fermented  drinks,  are  the  most  com- 
mon subjects  of  the  disease.  Among  persons 
who  are  addicted  to  the  excessive  use  of  alco- 
holic liquids,  it  is  observed  that  gout  occurs 
much  more  frequently  in  those  who  consume 


ON    GOUT.  139 

wine  and  malt  liquors,  than  in  those  who  are 
intemperate  in  distilled  spirits.  The  disease  is 
more  common  in  England  than  in  this  country, 
and  occurs  much  more  frequently  among  the 
wealthy  and  luxurious,  than  among  the  poorer 
and  laborious  classes. 

There  are  various  exceptional  forms,  under 
which  the  gouty  diathesis  may  become  appar- 
ent in  the  system.  Sometimes  the  viscera  be- 
come deranged,  without  obvious  affection  of 
the  joints,  constituting  irregular  or  concealed 
gout.  Thus  the  digestive  tube  may  be  affected 
with  nausea,  want  of  appetite,  pain,  flatulence, 
costiveness,  or  diarrhoea,  acid  eructations,  and 
even  vomiting.  In  the  thorax  are  sometimes 
felt  pain,  dyspnoea  and  palpitation,  and  in  the 
head,  vertigo,  diminution  of  sight  and  hearing, 
with  headache,  and  sometimes  numbness  and 
lethargic  heaviness.  The  spirits  are  excessively 
dejected,  and  the  mind  peevish  and  irritable. 
Sometimes  the  gouty  inflammation  attacks  the 
eye,  the  fauces,  or  the  urethra,  producing  symp- 
toms imitative  of  various  diseases. 

The  name    of  retrocedent  gout  is    applied, 
when  the  disease,  by  a  sudden  metastasis,  dis- 


140  ON    GOUT. 

appears  at  once  from  an  inflamed  joint,  and 
attacks  some  internal  organ  with  violent  and 
alarming  symptoms.  The  part  most  commonly 
seized  is  the  stomach,  in  which  there  is  sudden 
pain,  with  perhaps  nausea  and  vomiting,  and 
great  anxiety  and  distress.  The  heart  may  also 
be  attacked  with  syncope  and  urgent  dyspnoea, 
or  the  brain  with  symptoms  of  apoplexy  and 
^paralysis. 

The  prognosis  of  gout  is  not  unfavorable  in 
the  early  stages,  and  so  long  as  it  keeps  to  the 
.extremities.  But  the  retrocession  of  the  disease 
•to  the  stomach,  the  heart,  or  to  the  brain  and  its 
membranes  is  fraught  with  considerable  danger. 
The  prevalent  notion  that  gout  secures  an  im- 
munity from  other  diseases,  is  now  generally 
admitted  to  be  founded  in  error.  All  that  can 
be  said  to  be  true  is,  that  many  anomalous 
symptoms,  both  local  and  constitutional,  which 
depend  on  concealed  or  atonic  gout,  and  which 
may  have  harassed  the  patient  for  a  long  time, 
suddenly  give  way,  when  the  gout  declares 
itself  in  the  form  of  a  regular  paroxysm  in  the 
foot. 

In  its  diagnosis  gout  is  principally  liable  to 


ON    GOUT.  141 

be  confounded  with  rheumatism.  The  following 
circumstances  will  serve  to  distinguish  them. 
Gout  affects  the  small  joints,  principally  of  the 
great  toe.  Acute  rheumatism  attacks  chiefly 
the  large  ones,  and  often  many  at  a  time.  In 
gout,  the  inflamed  joint  is  of  a  vivid  red  color, 
it  afterwards  becomes  cedematous,  and  ends 
with  peeling  off  of  the  cuticle.  In  rheumatism 
the  joints  are  less  red,  and  the  cuticle  does  not 
desquamate.  Gout  is  more  paroxysmal  in  its 
character,  and  alternates  with  intervals  of  ease, 
more  than  rheumatism.  The  chalky  deposits 
are  characteristic  of  gout,  the  acid  perspirations 
of  rheumatism.  Gout  is  hereditary,  affects  the 
luxurious  and  indolent,  and  appears  after  pu- 
berty. Rheumatism  is  less  distinctly  hereditary, 
and  may  affect  persons  of  all  ages,  classes  and 
occupations. 

The  above  diagnostic  marks  appear  to  me  to 
constitute  a  legitimate  distinction  between  the 
diseases  of  gout  and  rheumatism.  It  is  but 
just  however  to  state,  that  these  distinctive 
characters  are  liable  to  numerous  exceptions, 
and  that  some  of  the  best  French  pathologists, 
such  as  Chomel,  Grisolle  and  Requin,  deny  the 


142  ON    GOUT. 

diversity  of  the  two  diseases.  And  experienced 
physicians  are  sometimes  at  a  loss  to  which  of 
these  forms  of  disease  they  shall  assign  particu- 
lar cases  which  exhibit  the  characteristics  of 
both. 

The  treatment  of  a  first  paroxysm  of  gout 
may  be  expectant  and  palliative,  for  it  is  not 
certain  how  soon  spontaneous  resolution  will 
arrive,  and  the  patient,  not  without  reason,  is 
taught  from  day  to  day  to  look  for  relief  and 
restoration  to  health.  Little,  therefore,  need  be 
done  except  to  open  the  bowels  with  some 
effectual  laxative,  and  to  apply  flannel  with 
camphorated  oil,  or  some  opiate  liniment.  But 
when  paroxysms  are  protracted  and  very  pain- 
ful, or  return  with  progressive  severity,  relief 
must  be  sought  from  such  means  as  are  in 
our  power.  Many  expedients  have  been  re- 
sorted to,  a  large  portion  of  which  are  liable 
to  serious  objections.  Immersion  of  the  foot 
in  cold  water  has  afforded  great  relief  to  the 
pain,  but  is  liable  to  drive  the  gout  to  vital 
organs.  Bleeding  has  been  found  to  mitigate 
the  inflammatory  action,  but  is  inadmissible  ex- 
cept in  the  most  robust  and  plethoric.  Leech- 


ON    GOUT.  143 

ing  the  afflicted  joint  is  an  useful  palliative, 
but  even  this  has  its  limits  of  expediency. 
Various  purgative  mixtures  have  in  turn  ob- 
tained and  lost  a  specific  reputation. 

The  remedy  which,  in  the  present  century, 
has  taken  precedence  of  all  others,  is  Colchi- 
cum.  This  drug,  supposed  to  be  the  basis  of 
a  French  gout  medicine  called  eau  medicinale, 
has  justly  acquired  reputation  for  the  power  of 
putting  an  immediate  stop  to  the  paroxysm. 
Five  grains  of  the  powdered  root,  or  three 
of  the  powdered  seeds,  or  from  thirty  to  forty 
minims  of  the  wine  of  colchicum  root,  may 
be  taken  three  times  in  a  day  by  a  vigorous 
adult.  If  the  medicine  is  good,  it  commonly 
purges  in  twenty-four  hours,  and  sometimes 
produces  vomiting,  with  prostration  of  strength, 
small  pulse,  and  cold  perspiration.  These  ef- 
fects give  evidence  of  the  full  action  of  the 
medicine,  but  are  not  always  necessary  to  the 
cure  of  the  gouty  paroxysm.  They  disappear 
after  the  colchicum  is  omitted. 

But  the  arresting  of  the  paroxysm  does  not 
involve  the  cure  of  the  disease.  This  more  im- 
portant result  requires  the  avoidance  of  the 


144  ON    GOUT. 

cause  of  the  evil.  The  prevention  of  future 
paroxysms  can  only  be  expected  from  a  careful 
and  rigidly  abstemious  regimen,  and  this  course, 
I  am  happy  to  believe,  will  be  found  effectual 
in  a  great  majority  of  cases.  I  have  known 
various  examples  of  persons  who  had  been 
severely  and  repeatedly  attacked  with  gout,  yet 
who  have  been  able  to  ward  off  subsequent 
attacks  indefinitely,  by  combining  a  life  of  ex- 
ercise with  total  abstinence  from  vinous  and 
stimulating  drinks.  This  method  does  not  al- 
ways succeed  in  confirmed  chronic  gout,  but  in 
preventing  the  returns  of  the  acute  disease  it 
is  eminently  successful.  And  although  in  cer- 
tain cases  where  the  structure  and  secretions 
have  become  radically  changed  by  the  arthritic 
diathesis,  there  is  little  hope  of  perfect  cure 
from  any  treatment,  yet  in  the  early,  and  some- 
times even  in  the  advanced  stages  of  this  mal- 
ady, the  recurring  paroxysms  are  postponed, 
mitigated,  or  totally  prevented  by  entire  absti- 
nence from  vinous  and  alcoholic  stimulants.  I 
have  the  happiness  to  be  able  to  allude  to  va- 
rious cases  of  gentlemen  well  known  in  this 
city,  in  some  of  whom  gout  has  been  heredi- 


ON    GOUT.  145 

tary,  in  others  of  long  duration  and  great  se- 
verity, as  in  those  already  cited  on  page  49,  in 
whom  an  almost  perfect  exemption  from  gout, 
of  indefinite  continuance,  has  followed  an  entire 
avoidance  of  stimulating  liquids. 


10 


TREATMENT   OF   INJURIES 

OCCASIONED    BY 

FIRE  AND  HEATED  SUBSTANCES. 

BEING  PART  OF  A  BOYLSTON  PKIZE  DISSERTATION  FOR  1812. 

THE  application  to  living  textures  of  sub- 
stances which  are  heated  beyond  a  certain  tem- 
perature, is  followed  by  the  phenomena  of  pain 
and  inflammation.  The  pain  is  of  a  peculiar 
kind,  resembling  that  from  the  continued  appli- 
cation of  fire  to  the  part ;  the  inflammation  has 
a  great  tendency  to  suppurate,  and  often  leaves 
a  contracted  cicatrix. 

The  communication  of  an  excess  of  caloric 
to  animal  bodies,  whether  living  or  dead,  is  fol- 
lowed by  certain  changes.  Of  the  fluids  some 
are  coagulated,  others  are  decomposed  or  even 
vaporized,  if  the  heat  be  sufficient.  The  solids 
are  in  a  greater  or  less  degree  expanded,  disor- 


INJURIES    BY    FIRE.  147 

ganized  or  decomposed ;  according  to  their  sus- 
ceptibility of  change  and  the  quantity  of  caloric 
received.  These  processes  in  the  living  body 
being  incompatible  with  its  healthy  condition,  a 
morbid  state  of  the  part  affected  necessarily 
ensues.  This  state  is  marked  by  pain,  redness? 
swelling,  vesication,  suppuration,  or  mortifica- 
tion ;  according  to  the  degree  and  extent  of  the 
injury  suffered. 

The  distressing  effects  of  these  injuries,  when 
they  exist  in  an  extensive  degree,  are  exceeded 
by  few  diseases.  Very  dangerous  cases  often 
occur  in  children,  whose  clothes  are  accident- 
ally kindled ;  in  intoxicated  persons,  who  fall 
into  the  fire ;  and  in  those  exposed  by  confla- 
grations, or  By  explosions  of  gunpowder,  steam 
boilers,  and  the  inflammable  gases  of  mines. 
The  peculiar  appearance  of  a  burnt  surface  has 
commonly  been  supposed  to  require  a  peculiar 
treatment;  and  many  practitioners,  instead  of 
resorting  to  the  general  remedies  of  inflamma- 
tion, have  placed  their  reliance  on  the  supposed 
powers  of  specific  remedies.  In  this  way  differ- 
ent and  opposite  modes  of  treatment  have  been 
adopted,  whose  apparent  success  or  failure  at 


148  TREATMENT    OF 

different  times  has  occasioned  disputes  respect- 
ing their  comparative  efficacy.  After  a  variety 
of  trials  have  been  made,  and  a  multitude  of 
cases  detailed,  the  practice  still  remains  unde- 
cided ;  and  methods  of  treatment  diametrically 
opposite  enlist  nearly  an  equal  number  of  advo- 
cates. 

The  two  modes  of  treating  burns  and  scalds, 
which  have  recently  acquired  the  greatest  share 
of  notice,  are  those  of  Mr.  Kentish  and  of  Sir 
James  Earle.  The  former  of  these  consists  in 
the  use  of  stimulant,  the  latter  of  cooling  appli- 
cations. 

Mr.  Kentish  recommends  that  the  injured 
surface  be  in  the  first  place  washed  and  bathed 
with  rectified  spirit  of  wine,  spirit  6f  turpentine, 
or  some  similar  application,  which  has  been 
previously  heated  as  far  as  it  can  be  borne  with 
the  finger.  After  this  bathing  has  been  re- 
peated two  or  three  times,  the  whole  is  then  to 
be  covered  with  plasters  made  of  common 
basilicon  or  resinous  ointment,  thinned  to  the 
consistence  of  a  liniment  with  spirit  of  turpen- 
tine. This  dressing  is  to  be  continued  for 
twenty-four  hours,  after  which  its  place  may  be 


INJURIES    BY    FIRE.  149 

supplied  with  some  less  stimulating  substance, 
such  as  proof  spirit  or  laudanum,  with  the 
coldness  taken  off.  At  the  end  of  forty-eight 
hours,  Mr.  K.  observes,  the  inflammation  will 
generally  be  found  to  have  disappeared,  at 
which  time  the  part  may  be  dressed  with  cam- 
phorated oil,  with  Goulard's  cerate,  or  with 
cerate  of  lapis  calaminaris. 

The  internal  treatment  recommended  by  Mr. 
Kentish  is  also  stimulant.  Wine,  ale,  alcohol 
or  laudanum,  are  advised  to  be  used  according 
to  circumstances. 

Sir  James  Earle,  in  a  publication,  entitled 
'  An  Essay  on  the  Means  of  lessening  the  Ef- 
fects of  Fire  on  the  Human  Body,'  defends  a 
mode  of  treatment  directly  the  reverse  of  the 
former.  This  consists  of  the  antiphlogistic  regi- 
men internally,  together  with  the  application  of 
cold  in  the  form  of  water,  snow,  or  pounded  ice, 
to  the  part  affected.  Sir  Walter  Farquhar  and 
Dr.  Kinglake  advocate  the  same  mode  of  pro- 
cedure ;  and  the  cases  related  to  substantiate 
the  happy  effect  of  the  cooling  treatment  are 
not  less  numerous  than  those  in  favor  of  the 
terebinthinate  remedies. 


150  TREATMENT    OF 

The  disputes  on  the  comparative  efficacy  of 
the  foregoing  plans  of  treatment  have  been  agi- 
tated with  so  much  warmth  and  so  little  impar- 
tiality, that  the  reader  of  them  is  like  to  end  his 
inquiries  in  scepticism  rather  than  conviction. 
Inconsistent  and  opposite  facts  are  often  stated, 
and  the  same  cases  distorted  to  prove  both 
points  of  the  dispute.  For  instance,  the  re- 
markable case  of  Boerhaave,  who  was  violently 
scalded  by  the  bursting  of  Papin's  digester,  and 
who  got  well  under  copious  bleeding  and  purg- 
ing, is  cited  by  one  as  an  instance  of  a  speedy 
and  fortunate  cure,  and  by  another  as  a  tedious 
and  difficult  recovery,  which  might  have  taken 
place  in  half  the  time  under  a  different  mode  of 
treatment.  The  source  of  this  uncertainty 
seems,  firstly,  to  consist  in  making  practical  de- 
ductions from  individual  or  insulated  cases, 
which  do  not  afford  sufficient  room  for  a  com- 
parison of  the  effect  of  different  remedies.  Such 
is  the  idiosyncrasy  of  different  constitutions,  and 
so  deceptive  the  appearance  of  different  injuries, 
that  it  is  often  impossible  to  pronounce  in  what 
degree  two  cases  resemble  each  other,  and  in 
what  degree  any  application  has  actually  expe- 


INJURIES    BY    FIRE.  151 

dited  or  retarded  the  cure.  According  to  the  ca- 
price or  prejudice  of  practitioners  the  account  of 
a  case  may  be  warped  and  colored  in  such  a 
manner  as  to  prove  any  point  of  a  dispute  that 
is  wished.  For  example,  should  any  one  come 
forth  as  the  advocate  for  a  negative  mode  of 
treating  burns,  which  should  consist  in  letting 
them  alone,  or  in  leaving  the  process  to  nature  ; 
there  is  no  doubt  that  in  due  time  he  would  be 
able  to  collect  a  sufficient  number  of  apparently 
satisfactory  cases  to  answer  all  his  purposes. 
The  multitude  of  cases  brought  forward  by  Mr. 
Kentish  and  his  opponents,  in  the  aggregate, 
seems  only  to  prove,  that'  oil  of  turpentine  and 
cold  water  are  both  salutary,  and  both  perni- 
cious, according  as  the  practitioner  who  watch- 
ed their  influence,  was  under  the  prejudices  of 
a  favorable  or  unfavorable  nature  toward  either 
application.  A  second  ground  of  error  is  like- 
wise contained  in  the  supposition  that  a  single 
and  specific  mode  of  treatment  can  be  accom- 
modated to  all  states  and  degrees  of  the  injuries 
occasioned  by  fire. 

It  is  obvious  that  many  more  cases  may  yet 
be  detailed,  which  will  not  bring  the  question, 


152  TREATMENT    OF 

in  the  least,  nearer  to  a  decision.  Though  a 
series  of  observations,  by  a  faithful  and  intelli- 
gent practitioner,  is  entitled  to  respect,  yet 
when  two  such  courses  present  us  with  results 
diametrically  opposite,  we  are  justified  in  doubt- 
ing the  validity  of  the  ground  on  which  they 
are  founded. 

It  occurred  to  me,  that  could  a  measure  be 
devised,  of  inflicting  two  equal  burns  on  cor- 
responding parts  of  the  same  animal,  which 
should  afterward  be  treated  with  different  ap- 
plications, that  a  chance  would  be  afforded  of 
testing  the  comparative  efficacy  of  these  appli- 
cations. With  this  view  the  following  experi- 
ments were  instituted,  which,  though  not  so 
numerous  and  complete  as  could  have  been 
wished,  will  not,  it  is  hoped,  be  thought  alto- 
gether inapplicable  to  the  object  for  which  they 
were  attempted. 

EXPERIMENT    I. 

The  two  ears  of  a  full  grown  rabbit  were 
immersed  in  water,  heated  near  to  the  boiling 
point.  Particular  care  was  taken  to  immerse 
both  ears  at  the  same  instant,  to  plunge  them 


•  INJURIES    BY    FIRE.  153 

to  the  same  depth,  and  to  withdraw  them  to- 
gether. In  this  way  two  scalds  were  obtained, 
as  nearly  as  possible,  equal;  since  they  were 
inflicted  by  the  same  substance  at  an  uniform 
temperature,  applied  for  an  equal  extent  and 
length  of  time  to  parts  corresponding  to  each 
other,  equidistant  from  the  centre  of  circulation, 
and  both  appertaining  to  the  same  subject. 
The  animal  was  now  suspended  on  his  back, 
with  his  right  ear  immersed  in  a  vessel  of  warm 
water,  at  about  100°  of  Fahrenheit ;  the  left  in 
a  vessel  of  cold  water,  having  its  temperature 
reduced  by  ice.  In  this  way  they  continued 
for  three  quarters  of  an  hour,  the  temperature 
of  both  vessels  being  kept  as  regular  as  possi- 
ble by  the  occasional  addition  of  warm  water 
and  of  ice.  The  two  ears  were  then  wiped  dry 
and  covered  with  common  resinous  ointment. 

2d  day.  —  The  right  ear,  to  which  warm 
water  had  been  applied,  was  red  and  opaque, 
but  the  skin  remained  sound ;  the  left  was  evi- 
dently more  inflamed,  and  contained  several 
small  vesications  and  excoriations.  The  heat  of 
both  was  somewhat  above  the  natural  standard. 

3d  day.  —  The   cuticle   had   separated  from 


154  TREATMENT    OF 

both  ears  to  some  extent,  but  most  from  the 
left,  to  which  the  cold  application  had  been 
made.  A  small  slough  likewise  separated  from 
this  ear. 

4th  day.  —  Additional  portions  had  separated 
from  both  ears,  but  most  from  the  left. 

From  the  fifth  to  the  eighteenth  day  both 
ears  continued  in  a  state  of  ulceration.  The 
tip  of  the  ears  having  been  the  first  part  im- 
mersed, and  the  last  withdrawn,  was  of  course 
the  most  intensely  scalded,  and  sloughed  off 
from  both  to  some  extent.  The  left  ear,  which 
had  undergone  the  cold  treatment,  suffered  most 
by  gangrene,  and  was  several  days  later  than 
the  other  in  healing. 

EXPERIMENT     II. 

The  two  ears  of  a  rabbit  were  immersed  in 
scalding  water  as  formerly.  The  right  ear  was 
covered  as  far  it  was  scalded  with  the  stimulat- 
ing ointment  of  Mr.  Kentish,  made  of  basilicon, 
thinned  to  the  consistence  of  a  liniment  with 
oil  of  turpentine.  To  the  left  ear  was  applied 
a  saponaceous  liniment,  composed  of  equal 
parts  of  lime  water  and  olive  oil. 


INJURIES    BY    FIRE.  '155 

Three  hours  afterward  the  ears  were  exam- 
ined. The  heat  of  both  was  much  increased 
but  that  of  the  right,  to  which  the  spirit  of  tur- 
pentine had  been  applied,  was  evidently  great- 
est. The  pain  of  this  ear  was  likewise  evinced 
by  the  animal  lopping  it  or  laying  it  on  its 
back,  while  the  other  was  carried  upright. 
Some  small  blisters  had  risen  on  this  ear,  but 
none  were  observed  on  the  other. 

2d  day.  —  Both  ears  were  preternaturally 
warm  and  red,  the  right  continuing  more  so. 
They  were  now  covered  with  resinous  oint- 
ment. 

3d  day.  —  A  part  of  the  tip  of  the  right  ear 
separated,  and  some  of  the  remainder  appeared 
destitute  of  sensation.  The  left  was  red  and 
inflamed,  but  with  no  appearance  of  mortifica- 
tion. 

4th  and  5th  days.  —  More  of  the  right  ear 
came  off.  The  left  was  ulcerated,  but  without 
any  appearance  of  gangrene. 

6th  —  8th  days.  —  The  ulceration  continued 
without  any  slough  from  the  left  ear.  About 
the  9th  day,  the  weather,  which  had  been  tem- 
perate, became  cool ;  and  the  ears,  which  were 


156  TREATMENT    OF 

kept  moist  by  the  ointment  and  their  own  dis- 
charge, became  constantly  cold.  To  this  cir- 
cumstance I  attributed  the  formation  of  a  con- 
siderable slough,  which  came  from  the  right  ear 
about  the  tenth,  and  from  the  left  on  the  four- 
teenth day.  Both  ears  soon  after  healed. 

EXPERIMENT    III. 

The  ears  of  a  rabbit  being  equally  scalded  as 
before,  the  right  was  covered  with  Mr.  Kentish's 
ointment,  while  the  left  was  immersed  in  cold 
water  with  ice  for  three  quarters  of  an  hour. 
The  left  was  then  covered  with  basilicon,  which 
ointment  on  the  second  day  was  applied  to 
both. 

2d  day.  —  The  right  ear  was  blistered,  and 
discharged  a  considerable  quantity  of  serum  or 
pus.  The  left  was  in  a  similar  situation,  but  in 
a  less  degree. 

3d  day.  —  Both  ears  were  in  a  state  of  sup- 
puration, but  the  right  much  the  worst;  the 
discharge  from  this  ear  being  general,  from  the 
other  partial. 

The  right  ear  continued  to  appear  the  worst 
during  the  recovery,  which  was  not  complete 


INJURIES    BY    FIRE.  157 

before  the  30th  day.  The  loss  of  substance  by 
sloughing  was  not  great  from  either  ear,  but 
was  least  from  the  left. 

EXPERIMENT     IV. 

A  fourth  rabbit  was  dipped  in  the  same 
manner  with  the  others;  afterwards  one  ear 
was  immersed  in  water,  the  other  in  proof 
spirit  at  the  temperature  of  the  room.  The 
scalds,  however,  proved  to  be  slight,  as  nothing 
ensued  but  a  trifling  redness  and  opacity  in  the 
parts  immersed,  which  disappeared  in  two  or 
three  days,  and  nearly  at  the  same  time  from 
both.  This  experiment  would  not  have  been 
mentioned,  did  it  not  serve  to  show  the  ground 
for  fallacy,  which  arises  from  comparing  the  cases 
of  different  individuals.  Had  the  result  of  this 
case  been  contrasted  with  any  of  the  former,  on 
presumption  that  the  injuries  received  were 
equal,  a  very  erroneous  deduction  might  have 
been  the  consequence. 

The  foregoing  experiments  were  conducted 
on  a  plan,  which,  I  conceive,  were  it  pursued  to 
a  considerable  extent,  would  approach  as  near 


158  TREATMENT    OF 

to  demonstrative  certainty,  as  any  subject  in 
conjectural  science  of  medicine  is  capable  of 
arriving.  A  desire  of  the  truth,  however,  obliges 
me  to  state  the  difficulties  which  remain,  and 
which  may  seem  to  detract  something  from  the 
weight  of  the  experiments.  The  ear,  which 
was  the  part  subjected  to  experiment,  is  com- 
posed chiefly  of  cartilage  and  skin ;  it  is  remote 
from  the  centre  of  circulation,  and  its  powers  of 
life  comparatively  feeble.  Possibly  a  different 
mode  of  treatment  may  suit  this  part,  from  that 
which  agrees  with  muscles  and  cellular  sub- 
stance. This  is  not  to  be  considered  as  very 
probable,  since  the  living  animal  fibre  is  apt  to 
exhibit  similar  phenomena  in  any  part  of  the 
body  under  the  influence  of  the  same  disease. 
If  any  peculiarity  existed  in  the  ear,  it  was 
probably  that  of  being  less  susceptible  of  the 
action  of  stimuli.  A  trial  would  have  been 
made  with  some  more  central  part,  had  the 
operation  been  equally  convenient.  A  second 
imperfection  in  these  experiments  was  caused 
by  the  accession  of  cold  weather,  which  appar- 
ently occasioned  a  more  extensive  gangrene, 
than  would  have  ensued  under  the  use  of  the 


INJURIES    BY    FIRE.  159 

remedies,  without  this  circumstance.  It  did 
not,  however,  occur  during  the  first  days,  so 
that  the  following  appearances  may  be  consid- 
ered as  free  from  fallacy. 

1st.  The  evident  increase  of  heat,  pain,  red- 
ness, vesication,  and  gangrene,  following  the 
application  of  oil  of  turpentine.  Exp.  n.  and 
in. 

2d,  The  increase  of  most  of  the  same  appear- 
ances, where  cold  water  was  used  in  contrast 
with  warm.  Exp.  i. 

As  comparative  cases  come  within  the  plan 
of  these  remarks,  the  following  case,  in  which 
different  remedies  were  applied  to  the  same 
subject,  is  extracted  from  the  Medical  and  Phys- 
ical Journal,  vol.  18,  page  209. 

*  Samuel  James,  aged  forty,  had  his  face, 
hands  and  back  most  severely  burnt  by  the 
explosion  of  hydrogen  gas  in  a  coal  mine. 
The  cold  application  was  used  to  the  face  and 
hands ;  the  warm  oil  of  turpentine,  according  to 
Mr.  Kentish's  plan,  (originally  recommended  by 
Heister,)  was  applied  to  the  back,  and  dressed 
afterward  with  unguent,  resinse  flav.  softened 
down  with  the  same :  in  order  to  try  which 


160  TREATMENT    OP 

mode  of  treatment  Ifforded  the  most  immediate 
ease  to  the  patient,  as  well  as  the  most  expedi- 
tious cure.  According  to  the  patient's  own 
account,  the  pain  of  the  hands  and  face  was 
immediately  relieved  by  the  cold  application, 
but  he  complained  of  the  oil  of  turpentine  oc- 
casioning a  smarting  sensation  on  the  back  for 
five  or  six  hours.  This  mode  of  dressing  was 
continued  for  the  space  of  two  days ;  but  ob- 
serving a  considerable  degree  of  inflammation 
remaining  from  the  terebinthinate  application, 
that  dressing  was  changed  for  the  neutralized 
cerate,  which  the  patient  did  not  observe,  his 
eyes  being  closed  by  the  great  tumefaction  of 
the  face ;  but  he  expressed  the  utmost  satisfac- 
tion from  the  superior  comfort  he  felt  in  that 
dressing  compared  with  the  former.  The  next 
day  the  back  appeared  much  less  inflamed,  con- 
tinued gradually  getting  better,  and  was  cured 
in  three  weeks.  "  I  am  confident,"  says  Dr. 
Evans,  the  relater  of  the  case,  "  the  back  would 
have  gotten  well  sooner  under  the  cooling  plan 
of  treatment;  for  the  patient  constantly  com- 
plained of  the  great  heat  in  the  part  during 
the  application  of  the  oil  of  turpentine." ' 


INJURIES    BY    FIRE.  161 

In  a  variety  of  cases  which  have  occurred 
under  my  own  observation,  it  has  not  been 
practicable  to  contrast  the  effects  of  different 
dressings :  so  that  little  of  a  decisive  nature 
can  be  gathered  from  them.  In  one  case,  how- 
ever, which  I  witnessed,  of  a  very  severe  and 
extensive  burn  in  a  child  aged  ten  years,  which 
was  occasioned  by  the  clothes  taking  fire,  and 
which  afterward  terminated  fatally;  the  appli- 
cation of  the  oil  of  turpentine  in  the  form  of  a 
liniment  produced  the  most  violent  aggravation 
of  pain,  which  did  not  cease  before  the  patient 
was  thrown  into  convulsions.  Instances  of  the 
same  effect  have  been  mentioned  to  me  by 
several  medical  friends. 

Most  writers,  who  appear  as  principal  advo- 
cates of  any  mode  of  practice,  feel  obliged  to 
produce  something  like  a  theory  or  rationale, 
which  shall  account  for,  or  at  least  apply  to  the 
facts  and  phenomena  adduced.  Accordingly, 
Mr.  Kentish  and  the  others  have  not  omitted 
to  back  their  catalogue  of  cases  with  a  train  of 
reasoning  illustrative  of  the  propriety  of  their 
special  applications.  Of  these  the  two  princi- 
pal are  entitled  to  a  separate  attention. 
11 


162  TREATMENT    OP 

OF     THE     STIMULANT    PLAN. 

In  defence  of  the  oil  of  turpentine  and  other 
stimulant  applications,  Mr.  Kentish  states  the 
following  as  a  law  of  the  system.  '  That  any 
part  of  the  system  having  its  action  increased 
to  a  very  high  degree,  must  continue  to  be  ex- 
cited, though  in  a  less  degree,  either  by  the 
stimulus  which  caused  the  increased  action,  or 
some  other  having  the  nearest  similarity  to 
it ;  until,  by  degrees,  the  extraordinary  action 
subsides  into  the  healthy  action  of  the  part.' 
It  has  also  been  urged  by  supporters  of  the 
plan,  that  a  lesser  stimulus,  as  the  oil  of  tur- 
pentine, is  comparatively  sedative  in  its  opera- 
tion on  a  part  violently  excited  by  a  burn.  The 
above  reasoning  may  amuse  the  imagination, 
but  does  not  satisfy  the  judgment.  The  anal- 
ogy of  almost  every  subject  in  medicine  and 
surgery  teaches  us,  that  a  part  already  highly 
irritated  receives  no  benefit  from  an  additional 
stimulus,  which  must  tend  only  to  increase  the 
sum  of  the  irritation.  If  a  man  bruise  his 
finger,  do  we,  by  way  of  expediting  the  cure, 
proceed  to  bruise  it  again,  but  with  less  vio- 
lence, because  '  it  must  continue  to  be  excited 


INJURIES    BY    FIRE.  163 

in  a  less  degree,'  '  until  the  extraordinary  action 
subsides  into  the  healthy  action  of  the  part  ? ' 
Or  if  a  man  has  received  an  hundred  lashes, 
shall  a  surgeon  prescribe  ninety  more,  because 
ninety  lashes  are  less  stimulating  than  an  hun- 
dred, and  therefore  comparatively  sedative? 
The  propriety  is  just  the  same,  when  we  irritate 
with  acrid  spirit  of  turpentine  a  part  already 
suffering  violent  pain  and  inflammation,  as  well 
as  increased  sensibility,  from  a  burn.  Though 
the  spirit  of  turpentine  applied  to  a  healthy 
surface  is  less  injurious  than  fire,  yet  if  we 
apply  the  one  to  a  part  already  injured  by  the 
other,  we  only  inflict  a  double  evil,  or  produce 
an  aggregate  of  the  mischief  of  both. 

With  regard  to  the  internal  stimulant  plan 
of  Mr.  Kentish,  it  is  advocated  on  a  ground 
not  less  exceptionable.  He  assumes  it  as  a 
fact,  that  '  a  healthy,  vigorous  man'  suffers  less 
by  a  burn  of  the  same  extent,  than  '  a  man  of 
an  irritable  habit;'  and  from  thence  he  infers 
that  strength  resists  the  ill  consequences  of 
these  injuries,  while  weakness  promotes  them ; 
and  that  therefore,  in  all  cases,  *  we  should 
make  the  system  as  strong  as  we  can  immedi- 


164  TREATMENT    OF 

ately  on  the  attack.'  Whether  this  principle 
be  just  may  very  properly  be  questioned,  since 
it  is  an  admitted  fact,  that  from  ordinary 
mechanical  injuries,  a  vigorous,  plethoric  man 
suffers  a  higher  degree  of  inflammation,  than 
one  whose  strength  and  quantity  of  blood  are 
less,  and  whose  powers  of  reaction  of  course 
are  more  feeble.  When  a  common  injury  takes 
place,  which  is  capable  of  producing  inflamma- 
tion and  symptomatic  fever,  depletion  and  the 
antiphlogistic  regimen  are  resorted  to  as  pre- 
ventives; and  this  in  a  greater  or  less  degree, 
according  as  the  subject  is  more  or  less  ple- 
thoric. For  instance,  if  a  vigorous  men  receive 
a  contusion  on  any  part  of  his  body,  so  violent 
as  to  endanger  suppuration  or  gangrene,  we 
prevent  or  mitigate  these  symptoms  by  blood- 
letting, purging,  and  abstinence.  Now  if  the 
same  man  had  received  a  burn  on  the  same 
part,  endangering  the  same  symptoms,  ought 
our  practice  to  be  different  ?  Is  the  system  so 
revolutionized  as  to  require  opposite  treatment, 
because  an  injury  is  caused  by  fire  instead  of 
mechanical  violence  ?  Or  is  a  stout  and  pletho- 
ric patient,  with  a  full,  hard,  and  frequent  pulse, 


INJURIES    BY    FIRE.  165 

to  be  stimulated  with  brandy  and  laudanum, 
because  his  fever  originated  in  a  burn  ?  It  is 
certainly  the  height  of  empiricism  to  prescribe  a 
specific  mode  of  treatment  for  a  disease,  merely 
from  its  name.  A  rational  treatment  is  always 
dependent  on  circumstances,  and  is  stimulant 
or  sedative,  according  to  the  constitution  of  the 
patient,  the  state  of  the  pulse,  and  the  condition 
of  the  system. 

OF     THE    COOLING    PLAN. 

Sir  James  Earle,  and  Dr.  Kinglake,  the  former 
in  his  Essay,  and  the  latter  in  the  Medical  and 
Physical  Journal,  have  advocated  a  mode  of 
treatment  precisely  opposite  to  that  of  Mr.  Ken- 
tish ;  yet,  like  him,  they  seem  to  have  erred  in 
pursuing  a  favorite  remedy  to  extremes.  The 
general  and  continued  application  of  cold  to  a 
part  injured  by  a  burn  or  scald,  is  resorted  to, 
from  a  belief  of  its  tendency  to  abstract  the 
excess  of  caloric  from  the  part,  and  to  restore 
the  equilibrium.  This  belief  is  a  just  one.  so 
far  as  it  applies  to  the  application  of  cold  for  a 
short  time,  immediately  after  the  injury  from  a 
heated  substance  is  received ;  but  the  continued 


166  TREATMENT    OF 

application  of  it  for  hours  and  days  on  the  same 
principle,  is  altogether  unphilosophical,  and  has 
been  sufficiently  refuted  in  the  treatise  of  Mr. 
Kentish.  Every  particle  of  caloric  communi- 
cated to  the  living  body  by  a  hot  substance, 
may  be  abstracted  in  one  minute  by  plunging 
the  part  affected  in  cold  water ;  and  if  this  im- 
mersion be  continued,  the  temperature  will  soon 
be  reduced  below  the  natural  standard.  It  is 
true  that  on  withdrawing  the  affected  part,  its 
temperature  will  soon  rise  to  the  former  pitch ; 
but  this  increased  temperature  can  be  nothing 
more  than  animal  heat,  a  little  increased  by  the 
violent  action  of  the  part,  as  happens  in  most 
cases  of  inflammation.  As  to  the  common 
phrase  of  'killing  the  fire,'  by  which  is  meant 
only  the  relief  of  pain  that  takes  place  at  the 
commencement  of  resolution  or  suppuration  ; 
this  cannot  be  hastened  by  cold  applications, 
except  in  slight  cases  which  admit  of  resolu- 
tion ;  whereas,  in  cases  where  blisters  have 
arisen,  and  suppuration  is  about  to  take  place, 
its  progress  is  only  retarded  by  the  employment 
of  cold. 

With  regard   to    the  antiphlogistic  regimen, 


INJURIES    BY    FIRE.  167 

nothing  more  need  be  said,  than  that  its  use  or 
omission  must  be  determined  altogether  by  the 
state  of  the  system. 

It  may  be  proper  in  this  place  to  say  some- 
thing respecting  the  use  of  alcohol,  ether,  and 
proof  spirit.  These  substances  are  often  re- 
commended in  a  vague  manner,  without  refer- 
ence to  the  mode  of  their  application,  although 
on  this  circumstance  depends  their  efficacy.  If 
a  part  of  the  body  be  washed  with  cold  spirit, 
or  a  thin  cloth  wet  with  spirit  be  applied,  the 
rapid  evaporation  which  takes  place,  renders 
the  effect  powerfully  refrigerant.  On  the  con- 
trary, if  the  part  be  immersed  in  spirit,  or  the 
spirit  be  applied  warm,  or  with  a  thickly  folded 
cloth,  its  operation  is  unquestionably  that  of  a 
stimulant. 

After  considering  at  length  the  opposite  ex- 
tremes of  treatment  which  have  been  adopted, 
the  result  of  both  reason  and  experiment  ap- 
pears to  be,  that  the  two  extremes  are  alike 
injudicious  when  pursued  in  their  full  extent, 
and  neither  of  them  suited  to  the  varieties  of 
burns  and  of  constitutions.  An  intermediate 
plan  of  treatment,  which  shall  vary  according 


168  TREATMENT    OF 

to  circumstances,  and  be  dependent  on  the  de- 
gree and  state  of  disease,  is  undoubtedly  the 
most  deserving  of  attention. 

In  slight  burns  where  no  vesications  take 
place,  and  where  resolution  appears  practicable, 
we  should  resort  to  cooling  applications,  either 
water  or  of  spirit ;  since  in  this  way  the  most 
speedy  relief  is  generally  given  to  the  pain,  and 
likewise,  as  in  other  inflammations,  resolution 
is  accelerated.  The  preparations  of  lead,  or  any 
other  discutient,  may  be  added  when  thought 
proper.  In  all  cases  of  burns  and  scalds  it  may 
be  expedient  to  make  one  application  of  cold 
water  as  soon  as  possible  after  the  injury,  to 
abstract  the  heat  from  the  clothes,  skin,  &c., 
and  prevent  the  spreading  of  its  effects. 

In  more  violent  burns,  attended  with  blisters 
and  acute  pain,  a  permanent  relief  is  to  be  ex- 
pected only  from  suppuration.  This  is  pro- 
moted, as  in  other  cases  of  suppurative  inflam- 
mation, not  by  acrid  stimulants,  not  by  snow 
and  ice ;  but  by  mild  emollients  and  warm  fo- 
mentations or  poultices.  Though  cold  applica- 
tions, by  benumbing  the  nerves,  may  afford  a 
temporary  relief  of  pain,  yet  this  returns  with 


INJURIES    BY    FIRE.  169 

equal  or  increased  violence  when  these  applica- 
tions are  discontinued;  so  that  they  must  be 
persevered  in  for  a  long  time,  until  tardy  sup- 
puration appears  in  spite  of  them,  before  effec- 
tual relief  is  given.  In  the  first  experiment  on 
the  rabbits,  the  ear  which  was  immersed  in  cold 
water  fared  worse  than  its  fellow,  which  was 
dipped  in  warm.  In  the  treatment  of  burns 
tending  to  suppuration,  perhaps  no  application 
is  better  than  a  liniment  of  lime  water  and  oil. 
This  is  very  gently  soothing  and  astringent, 
and  by  its  saponaceous  quality  unites  with  the 
discharge,  and  is  thus  more  generally  and 
equally  applied  than  any  unctuous  substance 
would  be  in  its  place. 

In  very  violent  burns,  where  the  life  of  a  part 
is  destroyed,  or  where  the  inflammation  is  so 
great  as  to  render  mortification  to  a  considera- 
ble extent  probable,  our  treatment  must  depend 
on  the  state  of  the  system  and  the  appearance 
of  the  part.  If  marks  of  active  inflammation 
are  present,  with  increased  heat  and  force  of 
circulation,  a  sedative  and  depleting  plan  is  to 
be  followed,  until  the  violent  action  has  abated. 
On  the  contrary,  if  the  inflammation  be  of  the 


170  INJURIES    BY    FIRE. 

passive  kind,  with  diminished  action  of  the 
part,  and  atony  and  prostration  of  strength  in 
the  system,  we  may  then  depend  on  stimulants 
and  antiseptics.  It  can  be  only  in  burns  of  this 
kind  that  Mr.  Kentish's  method  of  treatment 
is  admissible  in  any  extent. 

In  the  subsequent  treatment  of  burns,  if  ex- 
uberant granulations  arise,  they  may  be  re- 
pressed by  gentle  astringents,  by  pressure,  or  by 
escharotics.  Mr.  Kentish  recommends  powder- 
ed chalk,  but  this  I  have  found  insufficient 
when  mixed  with  a  third  part  of  burnt  alum. 
Pure  alum  answers  the  purpose  perfectly  well. 
The  separation  of  sloughs  is  facilitated,  ac- 
cording to  Mr.  Kentish,  by  introducing  pow- 
dered chalk  into  the  cavities  between  them  and 
the  living  parts. 

The  contraction  of  the  cicatrix  is  often  an 
unpleasant  consequence  of  burns.  It  may  be 
obviated  in  a  degree  by  a  proper  position  of 
the  cicatrizing  part.  Sometimes  the  contrac- 
tion is  so  great  as  to  impede  circulation  ;  in 
which  case  it  is  necessary  to  divide  the  newly 
formed  skin  in  different  places,  thus  allowing  it 
room  to  expand. 


BURIAL  OF  THE  DEAD. 


The  interest  which  the  author  has  felt  in  the  Cemetery  at 
Mount  Auburn,  the  first  of  its  kind  in  the  United  States,  has  in 
a  measure  grown  out  of  his  personal  connection  with  its  foun- 
dation and  subsequent  development.  The  project  of  Mount 
Auburn  was  originally  conceived,  the  preparatory  meetings 
called,  the  land  selected  and  engaged,  and  the  larger  public 
structures,  the  gate  chapel  tower  and  iron  fence  designed, 
by  himself  at  different  times.*  The  pleasure  of  witnessing, 
through  so  many  years,  the  progressive  improvement  of  this 
beautiful  spot,  has  been  enhanced  by  the  interest  and  active 
co-operation  of  many  of  our  distinguished  and  valued  citizens. 

While  the  subject  was  of  recent  agitation,  the  following  Ad- 
dress was  delivered  at  the  hall  of  the  Masonic  Temple,  before 
the  Boston  Society  for  the  Promotion  of  Useful  Knowledge. 

THE  manner  in  which  we  dispose  of  the 
remains  of  our  deceased  friends,  is  a  subject 
which,  within  the  last  few  years,  has  occupied 

*  Historical  notices  of  Mount  Auburn  have  been  published 
by  Thacher,  Walter,  Dearborn,  and  others,  also  in  the  Daily 
Advertiser,  Sept.  9,  1851,  and  the  Boston  Atlas,  Sept.  16,  1851. 


172  ON    THE    BURIAL 

a  greater  share  than  formerly  of  the  public  at- 
tention in  our  own  vicinity.  It  involves  not 
only  considerations  which  belong  to  the  gene- 
ral convenience,  but  includes  also  the  gratifica- 
tion of  individual  taste,  and  the  consolation  of 
private  sorrow.  Although,  in  a  strictly  philo- 
sophical view,  this  subject  possesses  but  little 
importance,  except  in  relation  to  the  conveni- 
ence of  survivors ;  yet  so  closely  are  our  sym- 
pathies enlisted  with  it,  so  inseparably  do  we 
connect  the  feelings  of  the  living  with  the  con- 
dition of  the  dead,  that  it  is  in  vain  that  we 
attempt  to  divest  ourselves  of  its  influence.  It 
is  incumbent  on  us  therefore  to  analyze,  as  far 
as  we  may  be  able,  the  principles  which  belong 
to  a  correct  view  of  this  subject;  since  it  is 
only  by  understanding  these,  that  we  may  ex- 
pect both  reason  and  feeling  to  be  satisfied. 

The  progress  of  all  organized  beings  is  to- 
wards decay.  The  complicated  textures  which 
the  living  body  elaborates  within  itself,  begin 
to  fall  asunder  almost  as  soon  as  life  has 
ceased.  The  materials  of  which  animals  and 
vegetables  are  composed,  have  natural  laws  and 
irresistible  affinities  which  are  suspended  during 


OF    THE    DEAD.  173 

the  period  of  life,  but  which  must  be  obeyed 
the  moment  that  life  is  extinct.  These  con- 
tinue to  operate,  until  the  exquisite  fabric  is 
reduced  to  a  condition,  in  no  wise  different 
from  that  of  the  soil  on  which  it  has  once 
trodden.  In  certain  cases  art  may  modify,  and 
accident  may  retard,  the  approaches  of  disor- 
ganization, but  the  exceptions  thus  produced 
are  too  few  and  imperfect,  to  invalidate  the 
certainty  of  the  general  law. 

If  we  take  a  comprehensive  survey  of  the 
progress  and  mutations  of  animal  and  vegetable 
life,  we  shall  perceive  that  this  necessity  of 
individual  destruction  is  the  basis  of  general 
safety.  The  elements  which  have  once  moved 
and  circulated  in  living  frames  do  not  become 
extinct  nor  useless  after  death ;  they  offer  them- 
selves as  the  materials  from  which  other  living 
frames  are  to  be  constructed.  What  has  once 
possessed  life  is  most  assimilated  to  the  living 
character,  and  most  ready  to  partake  of  life 
again.  The  plant  which  springs  from  the  earth, 
after  attaining  its  growth  and  perpetuating  its 
species,  falls  to  the  ground,  undergoes  decompo- 
sition, and  contributes  its  remains  to  the  nour- 


174  ON    THE    BURIAL 

ishment  of  plants  around  it.  The  myriads  of 
animals  which  range  the  woods,  or  inhabit  the 
air,  at  length  die  upon  the  surface  of  the  earth, 
and,  if  not  devoured  by  other  animals,  prepare 
for  vegetation  the  place  which  receives  their 
remains.  Were  it  not  for  this  law  of  nature, 
the  soil  would  be  soon  exhausted,  the  earth's 
surface  would  become  a  barren  waste,  and  the 
whole  race  of  organized  beings,  for  want  of 
sustenance,  would  become  extinct. 

Man  alone,  the  master  of  the  creation,  does 
not  willingly  stoop  to  become  a  participator  in 
the  routine  of  nature.  In  every  age  he  has 
manifested  a  disposition  to  exempt  himself,  and 
to  rescue  his  fellow,  from  the  common  fate  of 
living  beings.  Although  he  is  prodigal  of  the 
lives  of  other  classes,  and  sometimes  sacrifices 
a  hundred  inferior  bodies,  to  procure  himself  a 
single  repast,  yet  he  regards  with  scrupulous 
anxiety  the  destination  of  his  own  remains ; 
and  much  labor  and  treasure  are  devoted  by 
him  to  ward  off  for  a  season  the  inevitable 
courses  of  nature.  Under  the  apprehension  of 
posthumous  degradation,  human  bodies  have 
been  embalmed,  their  concentrated  dust  has 


OP    THE    DEAD.  175 

been  inclosed  in  golden  urns,  monumental  for- 
tresses have  been  piled  over  their  decaying 
bones ;  with  what  success,  and  with  what  use, 
it  may  not  be  amiss  to  consider. 

I  have  selected  a  few  instances,  in  which 
measures  have  been  taken  to  protect  the  human 
frame  from  decay,  which  will  be  seen  to  have 
been  in  some  cases  partially  successful,  in 
others  not  so.  They  will  serve  as  preliminaries 
to  the  general  considerations  which  are  con- 
nected with  the  subject. 

One  of  the  most  interesting  accounts  of  the 
preservation  of  a  body,  the  identity  of  which 
was  undoubted,  is  that  of  the  disinterment  of 
King  Edward  I.  of  England.  The  readers  of 
English  history  will  recollect  that  this  monarch 
gave,  as  a  dying  charge  to  his  son,  that  his 
heart  should  be  sent  to  the  Holy  Land,  but 
that  his  body  should  be  carried  in  the  van  of 
the  army  till  Scotland  was  reduced  to  obedi- 
ence. 

He  died  in  July,  1307,  and  notwithstanding 
his  injunctions,  was  buried  in  Westminster 
Abbey  in  October  of  the  same  year.  It  is  re- 
corded that  he  was  embalmed,  and  orders  for 


176  ON    THE    BURIAL 

renewing  the  cerecloth  about  his  body  were 
issued  in  the  reigns  of  Edward  III.  and  Henry 
IV.  The  tomb  of  this  monarch  was  opened, 
and  his  body  examined  in  January,  1774,  under 
the  direction  of  Sir  Joseph  Ayloffe,  after  it  had 
been  buried  four  hundred  and  sixty-seven  years. 
The  following  account  is  extracted  from  a  con- 
temporaneous volume  of  the  Gentleman's  Mag- 


'  Some  gentlemen  of  the  Society  of  Antiqua- 
ries, being  desirous  to  see  how  far  the  actual 
state  of  Edward  First's  body  answered  to  the 
methods  taken  to  preserve  it,  obtained  leave  to 
open  the  large  stone  sarcophagus,  in  which  it  is 
known  to  have  been  deposited,  on  the  north 
side  of  Edward  the  Confessor's  chapel.  This 
was  accordingly  done  on  the  morning  of  Janu- 
ary 2,  1774,  when  in  a  coffin  of  yellow  stone 
they  found  the  royal  body  in  perfect  preserva- 
tion, inclosed  in  two  wrappers;  one  of  them 
was  of  gold  tissue,  strongly  waxed,  and  fresh, 
the  other  and  outermost  considerably  decayed. 
The  corpse  was  habited  in  a  rich  mantle  of 
purple,  paned  with  white,  and  adorned  with 


OF    THE    DEAD.  177 

ornaments  of  gilt  metal,  studded  with  red  and 
blue  stones  and  pearls.  Two  similar  ornaments 
lay  on  the  hands.  The  mantle  was  fastened  on 
the  right  shoulder  by  a  magnificent  fibula  of 
the  same  metal,  with  the  same  stones  and 
pearls.  His  face  had  over  it  a  silken  covering, 
so  fine,  and  so  closely  fitted  to  it,  as  to  preserve 
the  features  entire.  Round  his  temples  was  a 
gilt  coronet  of  fleurs  de  lys.  In  his  hands, 
which  were  also  entire,  were  two  sceptres  of 
gilt  metal ;  that  in  the  right  surmounted  by  a 
cross  fleure,  that  in  the  left  by  three  clusters  of 
oak  leaves,  and  a  dove  on  a  globe ;  this  sceptre 
was  about  five  feet  long.  The  feet  were  envel- 
oped in  the  mantle  and  other  coverings,  but 
sound,  and  the  toes  distinct.  The  whole  length 
of  the  corpse  was  five  feet  two  inches.' 

This  last  statement,  it  will  be  observed,  is 
the  only  point  in  which  the  narrative  appears 
to  disagree  with  history.  We  are  generally 
given  to  understand  that  Edward  I.  was  a  tall 
man ;  and  that  he  was  designated  in  his  own 
time  by  the  name  of  Long-shanks.  Baker,  in 
his  Chronicle  of  the  Kings  of  England,  says  of 
12 


178  ON    THE    BURIAL 

him  that  he  was  tall  of  stature,  exceeding  most 
other  men  by  a  head  and  shoulders.  I  have  not 
been  able  to  find  Sir  Joseph  AylofFe's  account 
of  the  examination,  and  know  of  no  other  mode 
of  reconciling  the  discrepancy,  but  by  supposing 
a  typographical  error  of  a  figure  in  the  account 
which  has  been  quoted. 

Edward  I.  died  at  Burgh-upon-Sands,  in 
Cumberland,  on  his  way  to  Scotland,  July  7, 
1307,  in  the  sixty-eighth  year  of  his  age. 

Another  instance  of  partial  preservation,  is 
that  of  the  body  of  King  Charles  I.,  who  was 
beheaded  by  his  subjects  in  1649.  The  re- 
mains of  this  unfortunate  monarch  are  known 
to  have  been  carried  to  Windsor,  and  there 
interred  by  his  friends  without  pomp,  in  a  hasty 
and  private  manner.  It  is  stated  in  Claren- 
don's History  of  the  Rebellion,  that  when  his 
son,  Charles  II.,  was  desirous  to  remove  and 
re-inter  his  corpse  at  Westminster  Abbey,  it 
could  not  by  any  search  be  found.  In  con- 
structing a  mausoleum  at  Windsor  in  1813, 
under  the  direction  of  George  IV,  then  Prince 
Regent,  an  accident  led  to  the  discovery  of  this 
royal  body.  The  workmen,  in  forming  a  sub- 


OF    THE    DEAD.  179 

terraneous  passage  under  the  choir  of  St. 
George's  Chapel,  accidentally  made  an  aper- 
ture in  the  wall  of  the  vault  of  King  Henry 
VIII.  On  looking  through  this  opening  it  was 
found  to  contain  three  coffins,  instead  of  two, 
as  had  been  supposed.  Two  of  these  were 
ascertained  to  be  the  coffins  of  Henry  VIII, 
and  of  one  of  his  queens,  Jane  Seymour.  The 
other  was  formally  examined,  after  permission 
obtained,  by  Sir  Henry  Halford,  in  presence  of 
several  members  of  the  royal  family,  and  other 
persons  of  distinction.  The  account  since  pub- 
lished by  Sir  Henry,  corroborates  the  one  which 
had  been  given  by  Mr.  Herbert,  a  groom  of 
King  Charles's  bedchamber,  and  is  published 
in  Wood's  Athense  Oxonienses. 

'  On  removing  the  pall,'  says  the  account, 
'  a  plain  leaden  coffin  presented  itself  to  view, 
with  no  appearance  of  ever  having  been  in- 
closed in  wood,  and  bearing  an  inscription, 
"  King  Charles,  1648,"  in  large,  legible  charac- 
ters, on  a  scroll  of  lead  encircling  it.  A  square 
opening  was  then  made  in  the  upper  part  of 
the  lid,  of  such  dimensions  as  to  admit  a  clear 


180  ON    THE    BURIAL 

insight  into  its  contents.  These  were,  an  in- 
ternal wooden  coffin,  very  much  decayed,  and 
the  body  carefully  wrapped  up  in  cere-cloth, 
into  the  folds  of  which  a  quantity  of  unctuous 
matter,  mixed  with  resin,  as  it  seemed,  had 
been  melted,  so  as  to  exclude,  as  effectually  as 
possible,  the  external  air.  The  coffin  was  com- 
pletely full,  and,  from  the  tenacity  of  the  cere- 
cloth, great  difficulty  was  experienced  in  de- 
taching it  successfully  from  the  parts  which  it 
enveloped.  Wherever  the  unctuous  matter  had 
insinuated  itself,  the  separation  of  the  cere- 
cloth was  easy ;  and  where  it  came  off,  a  correct 
impression  of  the  features  to  which  it  had  been 
applied,  was  observed.  At  length  the  whole 
face  was  disengaged  from  its  covering.  The 
complexion  of  the  skin  of  it  was  dark  and  dis- 
colored. The  forehead  and  temples  had  lost 
little  or  nothing  of  their  muscular  substance ; 
the  cartilage  of  the  nose  was  gone ;  but  the  left 
eye,  in  the  first  moment  of  exposure,  was  open 
and  full,  though  it  vanished  almost  immediate- 
ly ;  and  the  pointed  beard,  so  characteristic  of 
the  period  of  the  reign  of  King  Charles,  was 
perfect.  The  shape  of  the  face  was  a  long 


OF    THE    DEAD.  181 

oval ;  many  of  the  teeth  remained ;  and  the  left 
ear,  in  consequence  of  the  interposition  of  the 
unctuous  matter  between  it  and  the  cere-cloth, 
was  found  entire. 

'  It  was  difficult,  at  this  moment,  to  withhold  a 
declaration,  that,  notwithstanding  its  disfigure- 
ment, the  countenance  did  bear  a  strong  resem- 
glance  to  the  coins,  the  busts,  and  especially  to 
the  picture  of  King  Charles  the  First,  by  Van- 
dyke, by  which  it  had  been  made  familiar  to  us. 
It  is  true,  that  the  minds  of  the  spectators  of  this 
interesting  sight  were  well  prepared  to  receive 
this  impression  ;  but  it  is  also  certain  that  such 
a  facility  of  belief  had  been  occasioned  by  the 
simplicity  and  truth  of  Mr.  Herbert's  Narrative, 
every  part  of  which  had  been  confirmed  by  the 
investigation,  so  far  as  it  had  advanced ;  and 
it  will  not  be  denied  that  the  shape  of  the 
face,  the  forehead,  the  eye,  and  the  beard,  are 
the  most  important  features  by  which  resem- 
blance is  determined. 

'When  the  head  had  been  entirely  disen- 
gaged from  the  attachments  which  confined  it, 
it  was  found  to  be  loose,  and  without  any  diffi- 
culty was  taken  out  and  held  up  to  view.  The 


182  ON    THE    BURIAL 

back  part  of  the  scalp  was  entirely  perfect,  and 
had  a  remarkably  fresh  appearance;  the  pores 
of  the  skin  being  more  distinct,  and  the  tendons 
and  ligaments  of  the  neck  were  of  considerable 
substance  and  firmness.  The  hair  was  thick  at 
the  back  part  of  the  head,  and  in  appearance 
nearly  black.  A  portion  of  it,  which  has  since 
been  cleaned  and  dried,  is  of  a  beautiful  dark 
brown  color.  That  of  the  beard  was  a  redder 
brown.  On  the  back  part  of  the  head  it  was 
not  more  than  an  inch  in  length,  and  had  prob- 
ably been  cut  so  short  for  the  convenience  of 
the  executioner,  or  perhaps  by  the  piety  of 
friends  soon  after  death,  in  order  to  furnish 
memorials  of  the  unhappy  king. 

*  On  holding  up  the  head,  to  examine  the 
place  of  separation  from  the  body,  the  muscles 
of  the  neck  had  evidently  retracted  themselves 
considerably;  and  the  fourth  cervical  vertebra 
was  found  to  be  cut  through  its  substance 
transversely,  leaving  the  surfaces  of  the  divided 
portions  perfectly  smooth  and  even,  an  appear- 
ance which  could  have  been  produced  only  by 
a  heavy  blow,  inflicted  with  a  very  sharp  instru- 
ment, and  which  furnished  the  last  proof  want- 
ing to  identify  King  Charles  the  First.' 


OF    THE    DEAD.  183 

The  foregoing  are  two  of  the  most  successful 
instances  of  posthumous  preservation.  The 
care  taken  in  regard  to  some  other  distinguish- 
ed personages  has  been  less  fortunate  in  its 
result.  The  coffin  of  Henry  VIII.  was  in- 
spected at  the  same  time  with  that  of  Charles, 
and  was  found  to  contain  nothing  but  the 
mere  skeleton  of  that  king.  Some  portions  of 
beard  remained  on  the  chin,  but  there  was  no- 
thing to  discriminate  the  personage  contained 
in  it. 

During  the  present  century,  the  sarcophagus 
of  King  John  has  also  been  examined.  It  con- 
tained little  else  than  a  disorganized  mass  of 
earth.  The  principal  substances  found,  were 
some  half  decayed  bones,  a  few  vestiges  of 
cloth  and  leather,  and  a  long  rusty  piece  of 
iron,  apparently  the  remains  of  the  sword-blade 
of  that  monarch. 

The  rapidity  with  which  decomposition  takes 
place  in  organic  bodies,  depends  upon  the  par- 
ticular circumstances  under  which  they  are 
placed.  A  certain  temperature,  and  a  certain 
degree  of  moisture,  are  indispensable  agents  in 
the  common  process  of  putrefaction,  and  could 


184  ON    T11E    BURIAL 

these  be  avoided  in  the  habitable  parts  of  our 
globe,  human  bodies  might  last  indefinitely. 
I  shall  be  excused  for  dwelling  a  short  time 
on  the  influence  of  some  of  these  preservative 
agents.  Where  a  certain  degree  of  cold  exists, 
it  tends  powerfully  to  check  the  process  of 
destructive  fermentation,  and  when  it  extends 
so  far  as  to  produce  congelation,  its  protecting 
power  is  complete.  Bodies  of  men  and  ani- 
mals are  found  in  situations  where  they  have 
remained  frozen  for  years,  and  even  for  ages. 
Not  many  years  ago,  the  bodies  of  some  Span- 
ish soldiers  were  found  in  a  state  of  perfect 
preservation  among  the  snows  of  the  Andes, 
where  they  were  supposed  to  have  perished  in 
attempting  to  cross  those  mountains,  nearly  a 
•century  ago ;  their  costume  and  some  historical 
records  indicating  the  probable  period  of  their 
expedition.  At  the  Hospice  of  the  Grand  St. 
Bernard  in  the  Alps,  some  receptacles  of  the 
dead  are  shown  to  travellers,  in  which,  owing  to 
the  effect  of  perpetual  frost,  together  with  the 
lightness  of  the  atmosphere,  but  little  absolute 
decay  has  taken  place  in  the  subjects  deposited 
during  a  lapse  of  years.  But  the  most  remark- 


OF    THE    DEAD.  185 

able  instance  of  preservation  by  frost  of  an 
animal  body,  is  that  of  an  elephant  of  an 
extinct  species,  discovered  in  1806  in  the  ice  of 
the  polar  sea,  near  the  mouth  of  the  river  Lena, 
by  Mr.  Michael  Adams.  This  animal  was  first 
seen  by  a  chief  of  the  Tonguse  tribe,  in  the 
year  1799,  at  which  time  it  was  imbedded  in  a 
rock  of  ice  about  one  hundred  and  eighty  feet 
high,  and  had  only  two  feet,  with  a  small  part 
of  the  body,  projecting  from  the  side,  so  as  to 
be  visible.  At  the  close  of  the  next  summer, 
the  entire  flank  of  the  animal  had  been  thawed 
out.  It  nevertheless  required  five  summers,  in 
this  inclement  region,  to  thaw  the  ice,  so  that 
the  whole  body  could  be  liberated.  At  length, 
in  1804,  the  enormous  mass  separated  from  the 
mountain  of  ice,  and  fell  over  upon  its  side, 
on  a  sand  bank.  At  this  time  it  appears  to 
have  been  in  a  state  of  perfect  preservation, 
with  its  skin  and  flesh  as  entire  as  when  it  had 
existed  antecedently  to  the  deluge,  or  to  what- 
ever convulsion  of  the  globe  may  have  trans- 
ported animals  apparently  of  the  torrid  zone  to 
the  confines  of  the  Arctic  circle.  The  Tonguse 
chief  cut  off  the  tusks,  which  were  nine  feet 


186  ON    THE    BURIAL 

long,  and  weighed  two  hundred  pounds  each. 
Two  years  after  this  event,  Mr.  Adams,  being 
at  Yakutsk,  and  hearing  of  this  event,  under- 
took a  journey  to  the  spot.  He  found  the 
animal  in  the  same  place,  but  exceedingly 
mutilated  by  the  dogs  and  wolves  of  the  neigh- 
borhood, which  had  fed  upon  its  flesh  as  fast 
as  it  thawed.  He  however  succeeded  in  re- 
moving the  whole  skeleton,  and  in  recovering 
two  of  the  feet,  one  of  the  ears,  one  of  the 
eyes,  and  about  three  quarters  of  the  skin, 
which  was  covered  with  reddish  hair  and  black 
bristles.  These  are  now  in  the  museum  at  St. 
Petersburg. 

The  foregoing  facts  are  sufficient  to  show 
that  a  low  degree  of  temperature  is  an  effectual 
preventive  of  animal  decomposition.  On  the 
other  hand,  a  certain  degree  of  heat  combined 
with  a  dry  atmosphere,  although  a  less  perfect 
protection,  is  sufficient  to  check  the  destructive 
process.  Warmth,  combined  with  moisture, 
tends  greatly  to  promote  decomposition ;  yet  if 
the  degree  of  heat,  or  the  circumstances  under 
which  it  acts,  are  such  as  to  produce  a  perfect 
dissipation  of  moisture,  the  further  progress  of 


OF    THE    DEAD.  187 

decay  is  arrested.  In  the  arid  caverns  of  Egypt 
the  dried  flesh  of  mummies,  although  greatly 
changed  from  its  original  appearance,  has  made 
no  progress  towards  ultimate  decomposition, 
during  two  or  three  thousand  years.  It  is 
known  that  the  ancient  Egyptians  embalmed 
the  dead  bodies  of  their  friends,  by  extracting 
the  large  viscera  from  the  cavities  of  the  head, 
chest  and  abdomen,  and  filling  them  with  aro- 
matic and  resinous  substances,  particularly  as- 
phaltum,  and  enveloping  the  outside  of  the 
body  in  cloths  impregnated  with  similar  mate- 
rials. These  impregnations  prevented  decompo- 
sition for  a  time,  until  perfect  dryness  had  taken 
place.  Their  subsequent  preservation,  through 
so  many  centuries,  appears  to  have  been  owing, 
not  so  much  to  the  antiseptic  quality  of  the 
substance  in  which  they  are  enveloped,  as  to 
the  effectual  exclusion  of  moisture. 

In  the  crypt  under  the  cathedral  of  Milan, 
travellers  are  shown  the  ghastly  relics  of  Carlo 
Borromeo,  as  they  have  lain  for  two  centuries, 
inclosed  in  a  crystal  sarcophagus,  and  bedecked 
with  costly  finery,  of  silk  and  gold.  The  pre- 
servation of  this  body  is  equal  to  that  of  an 


188  ON     THE    BURIAL 

Egyptian  mummy,  yet  a  more  loathsome  piece 
of  mockery  than  it  exhibits,  can  be  hardly 
imagined. 

It  will  be  perceived  that  the  instances  which 
have  been  detailed  are  cases  of  extraordinary 
exemption,  resulting  from  uncommon  care,  or 
from  the  most  favorable  combination  of  cir- 
cumstances, such  as  can  befall  but  an  exceed- 
ingly small  portion  of  the  human  race.  The 
common  fate  of  animal  bodies  is  to  undergo 
the  entire  destruction  of  their  fabric,  and  the 
obliteration  of  their  living  features  in  a  few 
years,  and  sometimes  even  weeks,  after  their 
death.  No  sooner  does  life  cease,  than  the 
elements  which  constituted  the  vital  body  be- 
come subject  to  the  common  laws  of  inert 
matter.  The  original  affinities,  which  had  been 
modified  or  suspended  during  life,  are  brought 
into  operation,  the  elementary  atoms  react  upon 
each  other,  the  organized  structure  passes  into 
decay,  and  is  converted  to  its  original  dust. 
Such  is  the  natural,  and,  I  may  add,  the  proper 
destination  of  the  material  part  of  all  that  has 
once  moved  and  breathed. 

The  reflections  which  naturally  suggest  them- 


OF    THE    DEAD.  189 

selves  in  contemplating  the  wrecks  o/  humanity, 
which  have  occasionally  been  brought  to  light, 
are  such  as  lead  us  to  ask,  of  what  possible 
use  is  a  resistance  to  the  laws  of  nature,  which, 
when  most  successfully  executed,  can  at  best 
only  preserve  a  defaced  and  degrading  image 
of  what  was  once  perfect  and  beautiful  ?  Could 
we,  by  any  means,  arrest  the  progress  of  decay, 
so  as  to  gather  round  us  the  dead  of  a  hundred 
generations  in  a  visible  and  tangible  shape ; 
could  we  fill  our  houses  and  our  streets  with 
mummies,  —  what  possible  acquisition  could 
be  more  useless,  what  custom  could  be  more 
revolting?  —  For  precisely  the  same  reason  the 
subterranean  vaults  and  the  walls  of  brick, 
which  we  construct  to  divide  the  clay  of  hu- 
manity from  that  of  the  rest  of  creation,  and  to 
preserve  it  separate  for  a  time,  as  it  were  for 
future  inspection,  are  neither  useful,  gratifying, 
nor  ultimately  effectual.  Could  the  individuals 
themselves,  who  are  to  be  the  subjects  of  this 
care,  have  the  power  to  regulate  the  officious 
zeal  of  their  survivors,  one  of  the  last  things 
they  could  reasonably  desire  would  be,  that  the 
light  should  ever  shine  on  their  changed  and 
crumbling  relics. 


190  ON    THE     BURIAL 

On  the  other  hand,  when  nature  is  permitted 
to  take  its  course,  when  the  dead  are  committed 
to  the  earth  under  the  open  sky,  to  become 
early  and  peacefully  blended  with  their  original 
dust,  no  unpleasant  association  remains.  It 
would  seem  as  if  the  forbidding  and  repulsive 
conditions  which  attend  on  decay,  were  merged 
and  lost  in  the  surrounding  harmonies  of  the 
creation. 

When  the  body  of  Major  Andre  was  taken 
up,  a  few  years  since,  from  the  place  of  its  in- 
terment near  the  Hudson,  for  the  purpose  of 
being  removed  to  England,  it  was  found  that 
the  skull  of  that  officer  was  closely  encircled  by 
a  network,  formed  by  the  roots  of  a  small  tree, 
which  had  been  planted  near  his  head.  This 
is  a  natural  and  most  beautiful  coincidence. 
It  would  seem  as  if  a  faithful  sentinel  had 
taken  his  post,  to  watch,  till  the  obliterated 
ashes  should  no  longer  need  a  friend.  Could 
we  associate  with  inanimate  clay  any  of  the 
feelings  of  sentient  beings,  who  would  not  wish 
to  rescue  his  remains  from  the  prisons  of  man- 
Kind,  and  commit  them  thus  to  the  embrace  of 
nature  ? 


OF    THE    DEAD.  191 

Convenience,  health  and  decency  require  that 
the  dead  should  be  early  removed  from  our 
sight.  The  law  of  nature  requires  that  they 
should  moulder  into  dust,  and  the  sooner  this 
change  is  accomplished,  the  better.  This  change 
should  take  place,  not  in  the  immediate  conti- 
guity of  survivors,  not  in  frequented  receptacles 
provided  for  the  promiscuous  concentration  of 
numbers,  not  where  the  intruding  light  may 
annually  usher  in  a  new  tenant,  to  encroach 
upon  the  old.  It  should  take  place  peacefully, 
silently,  separately,  in  the  retired  valley,  or  the 
sequestered  wood,  where  the  soil  continues  its 
primitive  exuberance,  and  where  the  earth  has 
not  become  too  costly  to  afford  to  each  occu- 
pant at  least  his  length  and  breadth. 

Within  the  bounds  of  populous  and  growing 
cities,  interments  cannot  with  propriety  take 
place  beyond  a  limited  extent.  The  vacant 
tracts  reserved  for  burial  grounds,  and  the 
cellars  of  churches  which  are  converted  into 
tombs,  become  glutted  with  inhabitants,  and 
are  in  the  end  obliged  to  be  abandoned,  though 
not  perhaps  until  the  original  tenants  have  been 
ejected,  and  the  same  space  has  been  occupied 


192  ON    THE    BURIAL 

three  or  four  successive  tiroes.  Necessity 
obliges  a  recourse  at  last  to  be  had  to  the 
neighboring  country,  and  hence  in  Paris,  Lon- 
don, Liverpool,  Leghorn,  and  other  European 
cities,  cemeteries  have  been  constructed  without 
the  confines  of  their  population.  These  places, 
in  consequence  of  the  sufficiency  of  the  ground, 
and  the  funds  which  usually  grow  out  of  such 
establishments,  have  been  made  the  recipients 
of  tasteful  ornament.  Travellers  are  attracted 
by  their  beauty,  and  dwell  with  interest  on  their 
subsequent  recollection.  The  scenes  which, 
under  most  other  circumstances,  are  repulsive 
and  disgusting,  are  by  the  joint  influence  of 
nature  and  art  rendered  beautiful,  attractive, 
and  consoling. 

The  situation  of  Mount  Auburn,  near  Boston, 
is  one  of  great  natural  fitness  for  the  objects 
to  which  it  has  been  devoted.  Independently 
of  its  superior  size,  it  may  be  doubted  whether 
any  spot,  which  has  been  set  apart  for  the 
same  purposes  in  Europe,  possesses  half  the 
interest  in  its  original  features.  In  a  few  years, 
when  the  hand  of  taste  shall  have  scattered 
among  the  trees,  as  it  has  already  begun  to  do, 


OF    THE    DEAD.  193 

enduring  memorials  of  marble  and  granite,  a 
landscape  of  the  most  picturesque  character 
wil  be  created.  No  place  in  the  environs  of 
our  city  will  possess  stronger  attractions  to  the 
visiter.  To  the  mourner  it  offers  seclusion, 
amid  the  consoling  influences  of  nature.  The 
moralist  and  man  of  religion  will 

'  Find  room 

And  food  for  meditation,  nor  pass  by 
Much,  that  may  give  him  pause,  if  pondered  fittingly.' 

"We  regard  the  relics  of  our  deceased  friends 
and  kindred  for  what  they  have  been,  and  not 
for  what  they  are.  We  cannot  keep  in  our 
presence  the  degraded  image  of  the  original 
frame ;  and  if  some  memorial  is  necessary  to 
soothe  the  unsatisfied  want,  which  we  feel 
when  bereaved  of  their  presence,  it  must  be 
found  in  contemplating  the  place  in  which  we 
know  that  their  dust  is  hidden.  The  history 
of  mankind,  in  all  ages,  shows  that  the  human 
heart  clings  to  the  grave  of  its  disappointed 
wishes,  that  it  seeks  consolation  in  rearing 
emblems  and  monuments,  and  in  collecting 
images  of  beauty  over  the  disappearing  relics 
13 


194      ON  THE  BUKIAL  OF  THE  DEAD. 

of  humanity.  This  can  be  fitly  done,  not  in 
the  tumultuous  and  harassing  din  of  cities, 
not  in  the  gloomy  and  almost  unapproachable 
vaults  of  charnel  houses ;  —  but  amidst  the 
quiet  verdure  of  the  field,  under  the  broad  and 
cheerful  light  of  heaven,  —  where  the  harmo- 
nious and  ever  changing  face  of  nature  reminds 
us,  by  its  resuscitating  influences,  that  to  die 
is  but  to  live  again. 


REMARKS  ON  PNEUMOTHORAX : 

WITH   CASES,   AND    AN   EXPERIMENTAL    INQUIRY   INTO   THE  CAUSES 
OF   THE  METALLIC  SOUNDS   HEARD  IN   THAT  DISEASE. 

[From  the  American  Journal  of  Medical  Sciences,  1839.] 

THE  sounds  which  are  heard  during  auscul- 
tation in  cases  of  pneumothorax,  especially 
when  life  has  been  prolonged  for  a  considerable 
time  under  the  disease,  have  a  character,  of 
which  the  term  metallic  is  eminently  descrip- 
tive. This  character  may  be  recognized  not 
only  in  the  respiration  and  cough,  but  frequently 
also  in  the  voice  and  the  succussion  and  percus- 
sion of  the  chest.  The  sound  is  either  sharp 
and  tinkling,  or  it  is  prolonged,  reverberating 
and  ringing,  according  to  the  kind  of  action 
under  which  it  is  produced.  In  both  cases  the 
mechanical  condition  of  the  chest  is  apparently 
the  same. 


196  REMARKS    ON    PNEUMOTHORAX. 

The  sounds  of  pneumothorax,  as  will  appear 
from  the  experiments  detailed  at  the  end  of 
this  article,  are  divisible,  with  relation  to  their 
causes,  into  those  of  impulse,  and  those  of  re- 
verberation. The  first  requires  the  presence  of 
liquid,  the  second  may  take  place  with  only  the 
presence  of  air.  The  first  includes  all  the  varie- 
ties of  metallic  tinkling  which  are  heard  in  res- 
piration, which  also  take  place  after  speaking 
and  coughing,  and  which  may  be  abundantly 
produced  in  many  cases  by  succussion  of  the 
chest.  When  well  developed  it  is  sharp,  silvery 
and  musical,  resembling  the  note  of  short  brass 
wires  in  certain  children's  toys.  The  second 
class,  that  of  reverberating  sounds,  includes  the 
varieties  of  amphoric  breathing,  and  may  be 
imitated  by  inflating  a  recent  bladder  to  a  con- 
siderable degree  of  tension  while  in  contact  with 
the  ear,  or  less  perfectly  by  blowing  into  a  glass 
or  metallic  vessel.  When  a  sudden  impetus  is 
given  to  it  by  coughing,  this  sound  becomes 
more  intense,  ringing  and  metallic.  The  voice 
also  at  times  acquires  the  metallic  resonance. 
If  percussion  be  performed  on  the  distended 
chest,  while  the  ear  is  applied  to  its  parietes,  a 


REMARKS    ON    PNEUMOTHORAX.  197 

ringing  sound  is  communicated,  having  more  or 
less  of  a  metallic  character. 

Metallic  tinkling  of  the  chest,  although  one  of 
the  most  marked  of  the  physical  signs,  appears 
not  to  have  been  fully  explained  in  regard  to 
the  immediate  cause  by  which  it  is  produced. 
Various  hypothetical  solutions  have  at  different 
times  been  offered,  but  all  of  them  have  been 
objected  to,  or  seem  liable  to  objections,  on  the 
score  of  insufficiency ;  and  no  one  of  them  ap- 
pears at  this  time  to  have  obtained  a  general 
assent.  A  brief  summary  is  sufficient  to  present 
the  leading  features  of  the  different  modes  in 
which  this  phenomenon  has  been  accounted  for. 

The  only  explanation  given  by  Laennec  of 
this  sound  is  by  him  considered  applicable  to 
cases  of  what  he  calls  simple  hydro-pneumotho- 
rax,  in  which  there  is  no  communication  with 
the  bronchise ;  a  form  of  the  disease,  however, 
the  existence  of  which  has  been  doubted  by 
some  subsequent  writers.  Laennec  says  that  if 
a  patient  happen  to  raise  himself  suddenly  in 
bed,  and  a  drop  of  fluid  fall  fron  the  upper  part 
of  the  cavity  of  the  pleura  into  the  fluid  beneath, 
it  produces  a  sound  like  that  occasioned  by  a 


198  REMARKS    ON    PNEUMOTHORAX. 

drop  of  water  let  fall  into  a  flask  three  quarters 
empty,  and  this  sound  is  immediately  followed 
by  a  distinct  metallic  tinkling.  A  similar  sound 
he  says  may  be  heard  by  ausculting  the  epigas- 
trium of  a  person  who  is  swallowing  water  in 
minute  quantities.  This  explanation  has  been 
adopted  by  various  subsequent  writers,  as  a 
general  mode  of  accounting  for  the  phenomenon 
of  metallic  tinkling. 

Dr.  C.  J.  B.  Williams,  author  of  valuable 
works  on  diseases  of  the  lungs  and  pleura,  ex- 
plains metallic  tinkling  on  the  principle  of 
reverberation  or  echo,  produced  in  a  cavity  of 
uniformly  reflecting  parietes  by  the  communica- 
tion of  a  sound,  or  of  a  soniferous  impulse  to 
the  air  contained  within  it.  He  considers  that 
in  common  cases  of  pneumothorax  communi- 
cating with  a  bronchus,  if  the  fistulous  opening 
be  small,  metallic  tinkling  will  be  produced,  but 
if  large,  or  if  several  such  openings  exist,  there 
will  be  only  amphoric  resonance. 

Dr.  Thomas  Davies,  in  his  lectures  at  the 
London  Hospital  on  diseases  of  the  chest,  says : 
'  The  metallic  tinkling  is  caused  by  the  reso- 
nance of  air  agitated  upon  the  surface  of  a 


REMARKS    ON    PNEUMOTHORAX.  199 

liquid  contained  in  a  preternatural  cavity  form- 
ed in  the  chest.'  *  This  explanation  may  have 
been  suggested  by  a  note  of  M.  Meriadec  Laen- 
nec  in  his  edition  of  the  great  work  of  his  rela- 
tive, who  says  that  the  sound  in  question 
appears  to  depend  upon  the  vibration  of  a  gas 
upon  the  surface  of  a  liquid. 

Dr.  James  Houghton,  author  of  the  article 
Pneumothorax  in  the  Cyclopedia  of  practical 
medicine,  adopts  the  idea  of  an  echo,  which  he 
derives  both  from  the  dropping  of  fluid  in  a 
cavity,  and  from  the  entrance  of  air  through  a 
fistulous  opening.  The  latter  variety,  he  says, 
appears  to  be  manifestly  the  echo  of  the  air 
forced  into  the  cavity,  reverberating  against  its 
hollow  parietes ;  and  the  sound,  he  thinks,  is 
more  particularly  caused  by  the  bursting  of 
minute  air  bubbles  at  the  orifice  of  the  fistula, 
formed  as  the  air  traverses  the  latter  by  the  en-, 
tanglement  of  mucus.  He  thinks  that  the  tink- 
ling will  be  more  or  less  loud  and  distinct  in 
proportion  as  the  fistulous  opening  is  larger  or 
smaller. 

*  London  Medical  Gazette,  Vol.  XV. 


200  REMARKS    ON    PNEUMOTHORAX. 

Mr.  Guthrie,  in  the  London  Medical  and  Sur- 
gical Journal,  1833,  asserts  that  Laennec,  and 
also  all  who  hold  that  metallic  tinkling  'depends 
entirely  on  the  passage  of  air  through  a  hole  in 
the  lung  into  the  cavity  of  the  thorax,'  have 
been  mistaken,  and  in  opposition  to  this  he 
mentions  that  to  produce  the  sound  in  question, 
the  air  in  the  cavity  must  necessarily  be  com- 
pressed. '  I  do  not,'  says  he,  '  deny  the  facts  of 
the  air,  the  hole  in  the  lung,  or  the  fluid  ;  but  I 
believe  that  to  produce  the  sounds  of  the  Jews' 
harp  (metallic  tinkling)  the  air  in  the  cavity 
must  be  greatly  compressed.' 

M.  Beau,  a  French  writer  on  the  causes  of  the 
respiratory  bruits,  is  not  satisfied  with  the  ex- 
planation of  Laennec,  and  contends  that  metal- 
lic tinkling  is  produced  by  a  bubble  of  air, 
which  having  traversed  the  fluid,  bursts  upon 
its  surface.  He  founds  his  opinion  on  the  fact, 
that  he  has  never  witnessed  metallic  tinkling, 
when  the  communication  with  the  external  air 
was  above  the  level  of  the  fluid.  Dr.  Spittal,  of 
Edinburgh,  seems  to  have  suggested  this  expla- 
nation of  metallic  tinkling  by  the  bursting  of  air 
bubbles,  as  early  as  1830. 


REMARKS    ON    PNEUMOTHORAX.  201 

Magendie,  in  his  lectures  quoted  in  the  Lan- 
cet of  1835,  says  :  '  The  causes  which  produce 
the  tlntement  metallique,  are  not  by  any  means 
well  understood.  Suppositions  have  been  made, 
(they  are  made  and  abandoned  with  surprising 
facility  in  medicine,)  but  when  we  come  to  ex- 
amine them,  we  find  nothing  but  mere  theories 
without  any  shadow  of  proof.'  He  tells  us  that 
the  supposition  that  a  drop  of  liquid  sticks  to 
the  upper  part  of  a  cavity  and  then  falls  into 
the  fluid  below,  is  mere  hypothesis,  which  may 
or  may  not  be  true.  He  also  denies  the  suffi- 
ciency of  the  explanation  that  the  tinkling  is 
caused  by  a  bubble  which  traverses  a  fluid,  and 
bursts  upon  its  surface.  His  objections  are 
grounded  on  an  experiment,  which  he  proceeds 
to  repeat  in  presence  of  his  class,  showing  the 
insufficiency  of  both  these  causes  to  produce 
metallic  tinkling.  In  a  dead  subject,  a  quantity 
of  fluid  amounting  to  about  half  a  pint  was 
thrown  into  the  chest.  A  perforation  was  then 
made  through  the  pulmonary  tissue,  so  as  to 
establish  a  communication  between  the  bronchi 
and  cavity  of  the  chest.  A  quantity  of  air  was 
then  forced  in  through  the  trachea,  so  as  to  enter 


202  REMARKS    ON    PNEUMOTHORAX. 

the  pleural  cavity.  No  metallic  sound  was  pro- 
duced in  the  operation.  Water  was  then  drop- 
ped in  through  an  opening  in  the  upper  part  of 
the  chest  upon  the  fluid  below,  but  this  also 
produced  no  tinkling.  Another  orifice  was 
made  in  the  lung  beneath  the  surface  of  the 
fluid,  and  air  injected  as  before.  A  bubbling 
sound,  or  'craquement'  was  heard  in  the  chest, 
'but  nothing  of  a  metallic  or  tinkling  character 
-could  be  perceived.  Magendie  considers  him- 
self as  having  disproved  the  explanations  to 
which  his  experiments  relate,  but  he  does  not 
offer  any  new  one  of  his  own. 

In  regard  to  M.  Guthrie's  explanation,  which 
supposes  the  necessity  of  compressed  air  being 
present,  this  has  been  effectually  set  aside  by 
the  fact,  that  although  in  extreme  pneumotho- 
rax,  the  air  in  the  pleura  is  moderately  com- 
pressed, yet  metallic  tinkling  is  known  to  be 
also  produced  in  large  tubercular  cavities  of  the 
lungs,  which  communicate  freely  with  the  at- 
mosphere, and  therefore  are  not  subject  to  any 
compression  whatever. 

The  solution  of  this  phenomenon  given  by 
Dr.  Davies,  and  Laennec  Junior,  that  it  is  caus- 


REMARKS    ON    PNEUMOTHORAX.  203 

ed  by  the  resonance  of  air,  agitated  upon  the 
surface  of  a  liquid,  seems  to  be  .too  vague  and 
unsupported  to  require  particular  attention. 

In  regard  to  the  explanations  given  by  Drs. 
Williams  and  Houghton,  which  ascribe  metallic 
tinkling  to  an  echo,  or  reverberation  of  air  from 
the  sides  of  a  cavity,  the  solution  seems  to  me 
to  be  neither  adequate  nor  very  probable.  Echo 
is  the  secondary  sound  produced  by  the  reflect- 
ed vibrations  of  the  atmosphere.  It  becomes 
powerful  only  when  many  reflections  converge 
towards  the  same  point.  Air,  moreover,  is  a 
feeble  conductor  of  sound,  when  compared  with 
liquid  or  solid  bodies.  It  is  unnecessary,  there- 
fore, to  suppose  that  one  of  the  most  striking 
sounds  heard  in  auscultation,  is  produced  by  the 
secondary  movement  of  a  feeble  conductor, 
when  we  have  between  the  ear  and  the  place  of 
impulse,  the  direct  agency  of  a  much  more  pow- 
erful conductor,  viz.  a  liquid.  To  elucidate 
this  point,  let  any  one  perform  the  following 
experiment.  Into  a  large  earthen  or  porcelain 
bowl,  pour  a  few  ounces  of  water.  Then  pro- 
duce a  slight  and  barely  audible  sound,  by  rub- 
bing or  snapping  together  the  ends  of  the  nails 


204  CASES    OF    PNEUMOTHORAX. 

of  the  thumb  and  finger.  If  this  sound  is  made 
in  the  air  in  any  part  of  the  cavity  of  the  bowl 
above  the  water,  it  remains  feeble,  but  if  the 
nails  be  immersed  below  the  surface  of  the  wa- 
ter, the  sound  instantly  becomes  augmented  to 
many  times  its  former  intensity,  and  it  will  be 
particularly  intense  to  the  ear  of  an  ausculter 
applied  to  the  outside  of  the  bowl.  Here,  then, 
is  a  parallel  case.  The  liquid  in  Pneumothorax 
and  not  the  air,  as  will  hereafter  be  seen,  con- 
veys the  sound  of  metallic  tinkling  to  the  walla 
of  the  chest,  and  these  transmit  it  to  the  ear  of 
the  ausculter,  constituting  an  uninterrupted 
chain  of  vibrations. 

Considering  the  subject  as  being  yet  imper- 
fectly explained,  and  therefore  open  to  further 
inquiry,  I  have  made  some  experiments  in  con- 
nection with  the  following  cases,  which  I  hope 
will  not  be  found  irrelevant  to  the  question. 

CASE  I.  —  J.  B.,  cordwainer,  aged  forty-four, 
entered  the  Massachusetts  general  hospital,  De- 
cember 28th,  1836.  He  had  been  troubled  with 
cough  and  dyspnrea,  during  most  of  last  year, 
increased  during  summer.  Yesterday,  after  ex- 


CASES    OF    PNEUMOTHORAX.  205 

posure  to  cold  during  perspiration,  had  a  sudden 
increase  of  cough  and  dyspnoea  with  pain  shoot- 
ing from  side  to  side,  and  hoarseness.  Now, 
skin  hot  and  dry,  face  flushed,  pulse  98,  respira- 
tion short,  quick,  50  per  minute,  cough  hard, 
with  viscid  frothy  mucous  sputa.  Complains  of 
pain  in  head  and  across  hypochondria  increased 
by  upward  pressure  or  cough,  tongue  white, 
costiveness,  dysury  with  frequent  micturition. 

29th,  31st.  Percussion  dull  on  right  back, 
sufficiently  resonant  on  left.  Respiration  very 
feeble  in  right  back,  with  a  slight  bronchial 
sound  opposite  spine  of  right  scapula.  Bron- 
chophony  well  pronounced  in  same  place.  Sup- 
plementary puerile  respiration  in  left  back. 
Hoarseness  amounting  to  aphonia,  cougli  fre- 
quent, painful,  with  dyspnoea.  About  |ii.  of 
muco-purulent  sputa  daily.  Costive ;  sleeps 
little. 

January  2d,  1837.  Has  rested  and  felt  some- 
what better  for  two  days.  In  right  back  respi- 
ration nearly  inaudible,  but  voice  and  cough 
distinctly  amphoric. 

4th.  By  degrees  the  respiration  in  right  back 
has  grown  more  audible,  and  amphoric.  Per- 


206  CASES    OF    PNEUMOTHORAX. 

cussion  resonant.  In  left  back  voice  natural, 
respiration  puerile.  Purulent  sputa,  one  to  three 
ounces. 

5th,  8th.  Metallic  tinkling  in  right  back,  at 
lower  edge  of  scapula,  slight  and  few,  heard  on 
each  day.  Amphoric  respiration;  voice  and 
cough  audible  from  summit  to  base  of  right 
chest.  Dyspnoea  and  cough  more  easy.  Per- 
cussion of  right  back  tympanitic  to  base  of 
chest ;  right  back  when  viewed  vertically  much 
more  prominent  to  the  eye  than  left ;  semi- 
circumference  an  inch  greater ;  intercostal  spaces 
prominent,  the  anterior  ones  level  in  supine  pos- 
ture. In  erect  posture,  base  of  right  chest  less 
resonant  than  when  lying  on  face  or  left  side. 

9th.  Paroxysms  of  great  dyspno3a,  obliging 
him  to  get  out  of  bed.  Breath,  voice  and  cough 
amphoric  from  summit  to  base  of  right  back. 
Frequent  metallic  tinkling.  Resonance  of  front 
and  back,  of  right  side  on  percussion.  Purulent 
sputa,  §iss. 

llth.  Rested  better ;  pulse  104 ;  anterior 
right  chest  tympanitic  on  percussion,  with  in- 
audible respiration  from  top  to  base ;  voice 
scarcely  audible  through  parietes  at  same  places 


CASES    OF    PNEUMOTHORAX.  207 

but  towards  base  amphoric.  Respiration  in 
right  back  feeble,  but  amphoric,  accompanied  by 
continual  metallic  tinkling,  frequent  and  rapid, 
resembling  the  boiling  of  a  fluid  in  a  glass  re- 
tort or  flask.  Respiration  highly  puerile  in 
whole  left  back  ;  slight  gurgling  under  clavicle. 
Very  great  exhaustion  and  anhelation,  after 
rising  to  cough.  Generally  unable  to  expecto- 
rate unless  he  turns  upon  his  left  side,  after 
which  movement  the  pus  flows  freely. 

12th,  13th.  Many  turns  of  violent  and  suffo- 
cative  dyspnoea  ;  metallic  tinkling  softer.  Res- 
piration in  right  back  very  feeble,  in  left  back 
puerile. 

14th,  16th.  Breathes  with  more  ease.  Some 
ounces  of  purulent  sputa  raised  each  day.  Am- 
phoric or  metallic  respiration,  voice  and  cough, 
with  metallic  tinkling  more  rare  and  feeble. 
Right  anterior  chest  quite  resonant  on  percus- 
sion, to  the  extreme  base  of  the  chest  on  inspi- 
ration, but  about  an  inch  less  in  extent  at  expi- 
ration. 

From  this  time  he  continued  delirious,  with 
occasional  twitching  of  muscles ;  respiration 
high  and  rapid  ;  inaudible,  or  amphoric,  in  right 


208  CASES    OF    PNEUMOTHORAX. 

front ;  faint  metallic  impulses  and  mucous  rales 
till  the  21st,  when  he  died. 

Autopsy,  two  and  a  half  hours  post  mortem. — 
Emaciation  not  great ;  right  side  of  thorax  en- 
larged ;  intercostal  spaces  obliterated,  this  side 
measuring  an  inch  more  than  the  left,  opposite 
the  lower  end  of  the  sternum.  Percussion  reso- 
nant, for  a  quarter  of  the  semi-circumference, 
flat  behind.  Succussion  of  the  chest  gives  a 
distinct  metallic  sound  from  the  motion  of  fluid. 
The  right  chest  when  perforated  through  water 
(see  Experiment  I.),  discharged  much  air,  and 
subsided  gradually. 

Thorax.  Right  pleura  with  strong  old  adhe- 
sions at  apex,  and  along  mediastinum ;  elsewhere 
covered  with  false  membranes,  mostly  free,  soft, 
whitish,  recent.  Its  cavity  contains  nearly  two 
quarts  of  opaque  sero-purulent  fluid,  with  de- 
tached flocculent  masses  of  lymph.  The  lung 
being  inflated  in  situ,  air  issued  freely  from  be- 
hind the  base  near  the  spine,  but  the  orifice 
could  not  subsequently  be  identified,  on  account 
of  the  rupture  of  cavities  made  in  removing  the 
adherent  lung  from  the  chest.  Right  lung 
greatly  compressed,  condensed,  and  nearly  de- 


CASES    OF    PNEUMOTHORAX.  209 

void  of  air,  the  upper  lobe  half  destroyed  by  an- 
abscess,  a  cavity  an  inch  square  in  the  upper 
part  of  the  lower  lobe,  and  tubercles  scattered 
through  all.  Left  pleura  with  some  old  adhe- 
sions. Lung  large,  somewhat  emphysematousr 
upper  and  lower  lobes  tuberculous,  a  cavity  ca- 
pable of  holding  §i.  in  the  upper  part  of  the 
lower  lobe.  Air  passages  of  natural  size,  some 
redness  in  right  bronchi.  Glands  at  bifurca- 
tion of  trachea  healthy  ;  those  in  upper  part  of 
thorax  and  the  cervical  enlarged  and  moist,  but 
not  tuberculous. 

Pericardium  contained  about  an  ounce  of 
turbid  serum,  with  flocculi  of  recent  lymph ; 
heart  healthy;  right  auricle  slightly  adherent; 
blood  in  right  side  partly  liquid,  partly  coagu- 
lated, with  some  fibrin ;  in  left  auricle  the  samey 
but  no  separate  fibrin. 

Abdomen.  Liver  of  average  size,  rather  dark 
and  friable,  pushed  down  so  as  to  reach  the  um- 
bilicus, compressed  so  that  its  superior  and 
anterior  surfaces  formed  a  right  angle.  Gall 
bladder  containing  §v.  of  very  dark  viscid  bile. 
Stomach  sufficiently  healthy,  except  some  small 
14 


210  CASES    OF    PNEUMOTHORAX. 

red  spots  about  the  small  curvature.     Mucous 
.  membrane  of  small  intestines  healthy. 

CASE  II.  —  I.  C.,  aged  forty-four,  sailor,  entered 
the  hospital  May  28th.*  He  was  previously  in 
the  house  three  months  ago  with  cough,  and 
slight  tuberculous  signs.  He  now  reports  that 
he  kept  at  work  continuing  pretty  well  until 
May  24th,  when  he  had  headache  and  dizziness 
in  the  afternoon,  referred  to  having  got  wet  in 
the  rain  the  night  before  ;  in  the  evening  faint- 
ed, and  in  the  night  had  coughing  and  retching; 
raised  without  pain  §ss.  more  or  less  of  frothy 
blood ;  has  had  much  cough  since,  mostly  in  the 
night,  with  scanty  expectoration  of  frothy  mu- 
cus; cough  and  long  inspiration  have  caused 
pain  in  the  right  side,  and  across  the  chest ;  has 
had  no  other  pain,  no  chills  nor  flushes ;  but  has 
perspired  considerably ;  has  had  little  appetite 
and  much  thirst,  bowels  have  been  open  daily ; 
urine  high  colored ;  feels  very  weak ;  tongue 
clean  for  most  part,  a  little  coated  at  roots ; 
pulse  118. 

*  This  case  was  most  of  the  time  under  the  care  of  Dr.  Hale. 


CASES    OF    PNEUMOTHORAX.  211 

29th.  Slept  better  than  out  of  house,  but 
coughed  considerably  towards  morning. 

30th.  Rested  badly  from  great  dyspnoea, 
which  came  on  between  nine  and  ten  last  night; 
bathed  in  a  sweat:  pulse  96;  mucous  rale  in 
the  throat ;  amphoric  sound  in  respiration  below 
left  scapula;  percussion  resonant  in  the  same 
place ;  respiration  puerile  on  the  other  side ;  lies 
on  the  right,  much  distressed  by  lying  on  the 
back  or  left  side.  Half  a  pint  of  thin  mucous 
fluid  sputa,  frothy  on  top  and  opaque. 

31st.  Rested  badly  from  dyspnoea  requiring 
him  to  maintain  a  stooping  posture ;  five  or  six 
dejections ;  pulse  132  sitting  up  ;  dyspnoea  now 
less  urgent;  a  highly  distinct  metallic  tinkle 
heard  in  the  left  chest,  disappearing  when  he 
stoops  forward,  returning  as  he  bends  back. 
Just  below  the  angle  of  the  left  scapula  strong 
amphoric  respiration  with  clear  metallic  tinkle. 
In  axillary  region  sound  as  of  striking  a  brass 
vessel  with  a  nail ;  great  resonance  of  the  left 
chest,  both  behind  and  in  front,  on  percussion. 
Strongly  puerile  respiration  in  the  right  back. 

June  1st.  Slept  half  the  night,  by  intervals, 
sitting  up  and  stooping  forward.  No  dejection ; 


212  CASES    OF    PNEUMOTHORAX. 

pulse  144 ;  tongue  moist,  thick  coat  on  centre, 
livid  ;  countenance  distressed,  anxious  ;  respira- 
tion 32,  laborious ;  no  pain  when  at  rest,  but  on 
motion  sharp  pain  through  the  left  chest,  below 
the  region  of  the  heart ;  speaks  only  in  a  whis- 
per ;  feet  and  ankles  cedematous ;  whole  left 
chest,  both  front  and  back,  very  resonant ;  respi- 
ration amphoric,  with  metallic  tinkling  loud  and 
musical  in  the  whole  left  back  below  spine  of 
scapula,  and  whole  left  front  from  clavicle  down- 
wards. 

2d.  Slept  pretty  well  in  the  same  posture  as 
last  night;  two  dejections;  countenance  anx- 
ious; skin  warm,  with  profuse  perspiration; 
pulse  144 ;  tongue  white  in  centre,  livid,  moist ; 
respiration  30,  laborious  ;  voice  better  than  yes- 
terday ;  amphoric  resonance  diminished ;  metal- 
lic tinkling  as  yesterday. 

3d.  Slept  pretty  well  in  his  chair,  as  before  ; 
pulse  128;  respiration  32,  somewhat  less  labori- 
ous, except  after  coughing  ;  unable  to  lie  down ; 
cough  not  frequent,  but  paroxysms  long  and 
severe ;  percussion  every  where  very  resonant 
in  left  chest  except  for  a  small  space  about  spine 
of  scapula,  where  it  is  only  equal  with  the  right ; 


CASES    OP    PNEUMOTHORAX.  213 

resonance  continues  to  the  very  base  of  chest ; 
respiration  vesicular,  but  feeble  about  spine  of 
scapula ;  amphoric  in  lower  half  of  back  ;  natu- 
ral respiration  without  metallic  tinkle;  after 
coughing  large  and  musical  tinkle  ;  in  front  no 
respiration  heard  below  line  one  inch  below 
nipple,  above  that  metallic  tinkle  for  the  space 
of  two  or  three  inches,  and  above  amphoric  reso- 
nance in  natural  respiration;  in  forced  respira- 
tion metallic  tinkle  over  whole  left  chest;  no 
resonance  of  voice ;  in  right  chest  respiration 
puerile. 

4th.  Slept  pretty  well  in  posture  as  for  the 
last  four  nights ;  countenance  less  distressed ; 
pulse  124 ;  cough  less  difficult,  but  still  labori- 
ous ;  about  §iss.  of  adhesive  muco-purulent 
sputa ;  skin  moist  and  warm  ;  resonance  of  left 
back  less  than  for  some  days  past,  though  still 
greater  than  natural  except  about  scapulae  ;  im- 
mediately over  and  above  scapulse,  percussion 
nearly  or  quite  equal  in  both  backs ;  on  two 
lower  ribs  of  left  back  percussion  resonant  while 
leaning  forward,  flat  on  leaning  backwards ; 
respiration  in  left  back  vesicular  about  scapulae 
and  for  an  inch  or  two  below,  then  amphoric  for 


214  CASES    OF    PNEUMOTHORAX. 

a  space  about  the  breadth  of  the  hand,  inaudible 
at  base ;  no  resonance  or  tremor  of  voice  disco- 
vered either  in  back  or  side ;  metallic  tinkling 
in  front  as  before;  also  in  back  after  cough. 
Sudamina  above  and  about  clavicles. 

5th.  In  bed  most  of  the  night  lying  on  right 
side ;  slept  two  or  three  hours  ;  four  or  five  de- 
jections ;  countenance  improved ;  §ii.  of  adhesive 
muco-purulent  sputa;  pulse  108;  tongue  clear 
at  edges,  moist,  coated  in  centre  ;  percussion 
resonant  down  to  sixth  rib  in  left  chest ;  flat 
immediately  below;  equal  in  both  backs  over 
scapulae,  and  for  two  fingers'  breadth  below; 
below  that  much  more  resonant  on  left  side, 
down  to  last  rib,  while  leaning  forward.  When 
leaning  back,  more  dull  in  the  whole  of  the  reso- 
nant space  in  back.  Natural  respiration  vesi- 
cular about  scapulae,  with  sonorous  rale  ;  below 
scapulae,  amphoric  resonance.  In  front,  metal- 
lic tinkle  after  cough ;  metallic  tinkle  also  in 
back.  No  resonance  of  voice  at  base  of  chest. 

7th.  In  chair  all  night ;  slept  three  hours  at 
intervals ;  five  dejections ;  countenance  more 
distressed ;  pulse  132 ;  respiration  36,  more  la- 
bored than  for  the  last  two  or  three  days. 


CASES    OF    PNEUMOTHORAX.  215 

Tongue  cleaner,  rather  less  livid  ;  nearly  |ii. 
adhesive  sputa ;  coughs,  he  thinks,  about  once 
an  hour ;  percussion  dull  in  back  on  lower  rib, 
when  leaning  forward  ;  respiration  amphoric 
both  in  front  and  back  ;  natural  breathing  unac- 
companied by  tinkle. 

8th.  Kept  awake  by  difficulty  of  breathing. 
Cough  less ;  expectoration  about  §i.  adhesive 
purulent  mucus.  Countenance  much  distressed, 
pulse  132 ;  tongue  more  coated  ;  respiration  32, 
labored.  Hair,  skin  and  clothing  wet  with  per- 
spiration. In  natural  respiration  very  little 
sound  perceived,  except  some  amphoric  reso- 
nance and  occasional  metallic  tinkling.  Per- 
cussion, when  leaning  much  forward,  flat  on 
lower  rib,  resonant  above ;  when  sitting  up, 
flat  on  four  lower  ribs.  A  peculiar  metallic 
ringing  sound  perceived  by  ear  applied  to  ster- 
num, when  the  back  is  percussed. 

llth.  In  chair  all  night;  slept  none  from 
dyspnoea;  some  pain  in  left  chest ;  two  dejec- 
tions ;  countenance  much  distressed ;  coughs 
little ;  expectoration  pretty  easy ;  §ii.  of  adhesive 
muco-purulent  sputa ;  pulse  144 ;  percussion 
flat  below  nipple,  also  in  back  below  corres- 


216  CASES    OF    PNEUMOTHORAX. 

ponding  line,  resonant  above;  sonorous  rale 
in  whole  front  chest.  No  other  sound  in  natu- 
ral breathing.  Amphoric  resonance  in  back, 
feeble  in  natural  breathing,  loud  and  musical 
after  cough.  After  speaking,  metallic  tinkling 
in  front. 

12th.  Lay  on  couch  all  night  without  having 
head  much  raised.  Could  lie  on  left  side  as 
well  as  right,  the  first  time  for  several  weeks. 
Rested  very  well,  but  did  not  sleep  much ;  one 
dejection  ;  respiration  36,  somewhat  labored, 
but  less  so  than  for  several  days  past.  Counte- 
nance less  distressed  ;  pulse,  after  waking,  108 ; 
tongue  much  less  livid,  moist,  with  a  broken 
coat  in  centre.  Percussion  of  left  chest  (still 
lying  on  left  side)  quite  resonant,  except  at  most 
dependent  part  of  side,  where  it  is  flat.  In 
natural  respiration,  the  only  sound  heard  is  sibi- 
lant rale  both  in  front  and  back.  Forced  respi- 
ration, either  in  speaking  or  other  effort,  ampho- 
ric. Coughed  but  little ;  less  than  §i.  adhesive, 
white,  frothy,  mucous  sputa.  Immediately  after 
rising,  loud,  ringing,  amphoric  resonance  in  res- 
piration, and  especially  in  cough,  heard  both  in 
back 'and  front.  Limit  of  flat  sound  on  sitting, 


CASES    OF    PNEUMOTHORAX.  217 

on  a  line  an  inch  below  the  nipple.  Same 
metallic  ringing  sound  on  percussion  of  chest  as 
before. 

13th.  In  erect  posture  most  of  night ;  slept 
little  from  dyspnrea;  three  dejections.  Dis- 
charge from  bowels  thin  and  watery ;  counte- 
nance moderately  distressed ;  perspiration  not 
excessive  ;  pulse  116,  tolerably  full ;  respiration 
36,  high,  laborious.  In  erect  position,  resonance 
on  percussion  extends  down  to  one  finger's 
breadth  below  nipple.  Below  this  line,  inter- 
costal spaces  on  a  level  with  ribs ;  above,  inter- 
costal spaces  projecting,  resonant.  In  ordinary 
respiration,  amphoric  resonance  loud  and  dis- 
tinct in  upper  part  of  chest  A  ringing  sound, 
on  percussion,  as  before.  No  metallic  tinkling 
heard.  Abdomen  full,  moderately  resonant. 

14th.  Slept  very  well,  lying  down,  on  either 
side  ;  four  dejections.  Countenance  less  dis- 
tressed ;  feels  better ;  pulse  108 ;  respiration  36, 
moderately  labored.  Inspiration  and  expiration 
nearly  equal.  Percussion  flat  below  line,  a  fin- 
ger's breadth  below  nipple,  resonant  above. 
Same  ringing  sound  as  before,  on  percussion. 
Sounds  of  fluid  readily  distinguishable  on  sue 


218  CASES    OF    PNEUMOTHORAX. 

cussion,  heard  with  ear  at  a  distance  of  a  foot 
from  chest.  Moderate  amphoric  resonance  in 
ordinary  respiration.  Two  sides  of  chest  nearly 
equal  on  measurement ;  left  mamma  more  prom- 
inent to  the  eye  than  right,  intercostal  spaces 
protruding  slightly.  After  some  fatigue,  am- 
phoric resonance,  ringing.  Ribs  of  left  chest 
scarcely  raised  in  respiration. 

15th.  Slept  pretty  well,  mostly  in  sitting 
posture;  three  dejections.  Breathing  more  dif- 
ficult when  he  attempted  to  lie  down.  Coun- 
tenance anxious  and  distressed ;  skin  quite  cool, 
wet  with  perspiration ;  large  sudamina  about 
clavicles ;  respiration  36,  laborious.  Inspiration 
quicker  than  expiration.  Cough  little.  Percus- 
sion about  spines  of  scapulae  still  equal  on  both 
sides.  Ordinary  respiration  amphoric  and  ring- 
ing; when  a  little  forced,  voice  and  percussion 
ringing  as  before.  Sound  of  fluid  on  succussion 
heard  at  distance  of  several  feet. 

17th.  Slept  most  of  night  in  sitting  posture 
and  recumbent,  lying  on  back  or  right  side. 
Countenance  much  distressed ;  respiration  quite 
laborious  ;  inspirations  quick  ;  pulse  112. 
Tongue  moist,  slight  coat  on  lobes,  very  slightly 


CASES    OF    PNEUMOTHORAX.  219 

livid ;  skin  cool  and  moist.  Pain  near  left  nip- 
ple if  he  lies  on  left  side  ;  no  pain  when  at  rest 
in  any  other  position.  Very  little  cough,  §ii. 
frothy  mucous  sputa.  Line  of  flat  sound  level 
with  nipple ;  respiration  in  right  chest  loud  and 
coarse.  Sounds  in  left  chest  as  before.  Ring- 
ing sound  on  percussion  perceptible  when  per- 
cussion is  on  same  surface  with  ear,  in  erect 
position. 

18th.  At  six  and  a  half  A.  M.  found  lying 
on  back  with  shoulders  raised,  breathing  quick 
and  with  tracheal  rale.  Eyes  closed  ;  pulse  very 
small  and  feeble  ;  extremities  cold.  Died  soon 
after. 

Autopsy,  eight  hours  post  mortem.  Body  not 
much  emaciated,  skin  livid,  lower  extremities 
cedematous. 

Left  chest  quite  resonant  to  a  line  with  axilla, 
flat  behind  this  line.  Right  side  dull  over  whole 
space  below  pectoral  muscles.  The  air  rushed 
out  from  a  perforation  on  left  side,  as  detailed 
in  Experiment  I.  Left  pleura  universally  in- 
flamed, mostly  red  and  roughened,  and  lined 
with  a  soft,  bluish-white  false  membrane  of 
variable  thickness,  separable  in  some  places  into 


220  CASKS    OF    PNEUMOTHORAX. 

layers,  containing  about  five  pints  of  thin,  puru- 
lent, inodorous  liquid,  with  coarse  masses  of 
lymph  lying  loose  in  the  depending  parts.  Left 
lung  collapsed  very  small,  fleshy,  bluish-black, 
pressed  against  spine  and  ribs,  and  nearly  des- 
titute of  air,  having  a  coat  of  lymph,  and  ad- 
hering behind  superiorly.  A  rounded  fistulous 
opening  was  found,  half  a  line  in  diameter,  and 
situated  on  the  posterior  surface  of  the  lower 
lobe,  an  inch  and  a  half  below  its  summit. 
Through  this  orifice  air  issued,  if  blown  into 
the  trachea,  and  a  probe  pressed  upwards  enter- 
ed a  large  bronchus.  This  opening  communi- 
cated immediately  with  a  superficial  cavity  an 
inch  long  by  half  an  inch  broad,  and  which  con- 
tained a  whitish,  friable,  opaque  substance.  No 
other  cavity  was  found,  but  small  tubercles  and 
gray  granulations  in  various  parts  of  this  lung. 
The  bronchi  contained  bloody  fluid,  were  pale, 
thin  and  polished,  excepting  that  which  led  to 
the  cavity,  and  which  was  thickened,  darker, 
and  less  polished. 

Right  lung  universally  adherent  by  pale,  soft, 
friable,  recent  membrane,  forming  bands  below, 
some  of  them  an  inch  long,  among  which  were 


CASES    OF    PNEUMOTHORAX.  221 

cavities,  containing  gviii.  of  reddish  fluid.  This 
lung  contained  many  tubercles,  and  a  cavity  an 
inch  long  at  its  apex. 

In  front  of  the  neck  was  a  tumor,  occasioned 
by  an  abscess  situated  between  sterno-hyoid 
muscles,  containing  iss.  of  pus,  with  a  lining  of 
tuberculous-looking  matter. 

Pericardium  pushed  to  the  right  side,  more 
than  two-thirds  of  it  beyond  the  median  line. 
Heart  healthy,  except  perhaps  slight  hypertrophy 
of  left  ventricle,  which  measured  five-eighths  of 
an  inch  thick  at  base,  and  five-sixteenths  at 
apex.  Weight,  nine  and  a  half  ounces. 

Liver  somewhat  enlarged,  rather  dark,  pushed 
down  within  an  inch  or  two  of  the  umbilicus. 
Small  intestines  tuberculous,  especially  on  Pey- 
er's  plates,  towards  the  end  of  the  ilium,  but  no 
ulcers.  Other  viscera  mostly  natural. 

CASE  III. —  A.  C.,  a  young  gentleman,  aged 
twenty,  called  me  to  visit  him  June  28th,  having 
just  returned  from  a  journey  to  the  South.  He 
reported,  that  two  years  previously  he  had  had 
a  '  lung  fever,'  since  which  time  his  health  has 
not  been  good.  Last  summer  he  was  troubled 


422  CASES    OF    PNEUMOTHORAX. 

with  slight  pains  in  the  chest,  emaciation,  loss 
of  strength,  and  some  hectic  symptoms,  but 
does  not  recollect  much  cough.  Being  consid- 
ered phthisical  by  his  physician,  he  had  been 
advised  to  pass  the  winter  in  the  southern  states. 
My  first  visit  was  made  to  him  on  the  second 
day  after  his  return,  and  one  day  before  his 
death.  I  found  him  thin  and  feeble,  barely  able 
to  sit  up,  with  a  hot  skin  and  circumscribed 
redness  on  his  cheek.  Dyspnoea  by  no  means 
urgent,  decubiture  dorsal,  pain  and  stricture 
across  both  hypochondria,  and  none  felt  else- 
where ;  pulse  80.  Left  chest  tympanitic,  respi- 
ration inaudible  ;  a  slight  metallic  tinkle  heard 
singly  at  each  inspiration  and  expiration.  Pul- 
sations of  heart  feeble  in  cardiac  region,  stronger 
on  right  side.  On  the  follqwing  day,  without 
any  great  aggravation  of  dyspnoea  or  distress, 
he  became  much  prostrated,  with  a  small,  irreg- 
ular pulse,  cold  sweats,  and  diminished  sensi- 
bility, and  died  on  the  succeeding  night.  By 
his  own  testimony  and  that  of  his  friends,  his 
cough  had  been  slight,  and  the  dyspnoea  at  no 
time  urgent. 

Autopsy,   sixteen    hours    after   death.      The 


CASES    OF    PNEUMOTHORAX.  223 

whole  anterior  chest  resonant,  the  left  tympa- 
nitic.  On  perforating  the  left  chest  through 
water,  great  quantities  of  air  escaped.  [See  Ex- 
periment L]  The  quantity  of  sero-purulent 
fluid  was  not  estimated,  water  having  been 
thrown  into  the  chest  for  the  sake  of  the  ex- 
periment. The  left  lung  was  adherent  supe- 
riorly and  posteriorly,  and  had  tubercles  and 
cavities  in  its  upper  lobe.  The  lower  part  of 
the  same  lobe  was  indurated  by  tuberculous 
infiltration,  and  had  about  the  color  of  gray 
hepatization.  No  communication  between  the 
bronchise  and  chest  was  detected  except  those 
produced  in  the  cavities  torn  in  the  separation. 
Right  lung  healthy,  excepting  a  few  tuberculous 
lumps  in  its  upper  lobe.  The  heart  was  very 
small  and  flaccid,  and  was  pushed  almost 
wholly  into  the  right  chest.  Mitral  valves  some- 
what thickened  at  their  roots  with  slight  vege- 
tation. Liver  depressed,  dark  purple,  flaccid. 
GaU-bladder  healthy. 

I  consider  the  last  case  as  noticeable  for  the 
absence  of  any  great  dyspnoea  or  distress,  after 
the  signs  of  pneumothorax  were  so  distinct  as 
to  lead  to  an  unequivocal  diagnosis  of  that  dis- 


224  CASES    OF    PNEUMOTHORAX. 

ease.  I  have  seen  similar  cases  where  the  pneu- 
mothorax  was  partial,  owing  to  the  adhesions 
of  the  lung  preventing  collapse,  a  case  not 
wholly  uncommon. 

EXPERIMENT  I.  —  Previously  to  the  autopsies 
of  the  patients  who  were  the  subjects  of  Cases 
I.  and  II.,  a  glass  cylinder,  open  at  both  ends, 
was  pressed  into  close  contact  with  the  chest,  so 
as  to  hold  water.  Some  ounces  of  that  fluid 
were  poured  in,  and  a  perforation  was  made 
through  it,  into  the  cavity  of  the  chest  on  the 
distended  side.  Immediately  a  large  volume  of 
air  escaped  from  the  chest,  bubbling  upwards 
through  the  water.  In  the  third  case,  no  cylin- 
der being  at  hand,  a  superficial  cavity  was  made 
out  of  the  dissected  integuments  of  the  chest, 
and  filled  with  water.  Through  this  water  a 
perforation  of  the  chest  was  made  on  the  left 
anterior  surface.  The  air  rushed  out,  producing 
strong  ebullition,  as  in  the  former  cases.  The 
experiment  was  then  repeated  on  the  right  side, 
and  the  perforation  made  through  water  as  be- 
fore. No  air  in  this  instance  escaped,  but  the 
water  was  immediately  sucked  into  the  chest 
by  the  atmospheric  pressure. 


EXPERIMENTS.  225 

EXPERIMENT  II.  —  Artificial  respiration  was 
produced  in  the  body  of  the  subject  of  Case  II., 
by  inflating  the  lungs  through  the  trachea,  and 
expelling  the  air  by  pressure  on  the  abdomen. 
At  each  inflation,  a  most  distinct,  clear  and 
abundant  metallic  tinkling  was  produced,  ac- 
companied with  more  or  less  amphoric  sound, 
and  could  be  sustained  ad  libitum  by  repeating 
the  inflation.  The  sound  was  recognized  by 
several  of  the  medical  gentlemen  attached  to 
the  hospital,*  as  being  the  same  which  had  ex- 
isted during  the  patient's  life. 

This  experiment  was  repeated  in  the  exam- 
ination of  the  body  of  the  patient  in  Case  III. 
It  produced  amphoric  sound,  but  no  tinkling. 
The  latter  symptom,  it  will  be  observed,  was 
but  feebly  perceptible  in  examinations  during 
life. 

EXPERIMENT  III. —  Through  an  aperture  in 
the  anterior  part  of  the  chest  in  the  subject  of 
Case  II.,  a  catheter  was  introduced  and  air 
blown  through  it  into  the  cavity  of  the  left 
pleura.  While  the  end  of  the  catheter  was 

*  Among  the  gentlemen  present  were  Drs.  Hale,  Strong, 
Bowditch  and  Sargent. 
15 


*226  CASES    OF    PNEUMOTHORAX. 

above  the  level  of  the  fluid,  a  strong  amphoric 
buzzing  was  communicated  to  the  ear  of  an  ob- 
server in  contact  with  the  chest.  But  when  the 
end  of  the  instrument  was  pushed  below  the 
surface  of  the  liquid,  and  the  latter  made  to 
bubble  by  continuing  the  inflation,  an  exquisite 
metallic  tinkling  was  heard  at  the  explosion  of 
each  bubble,  resembling,  as  it  had  done  in 
life,  the  sound  of  a  little  bell  or  musical  wire. 
In  the  subject  of  Case  III.  this  experiment 
was  repeated,  and  varied  by  pouring  into  the 
chest  different  quantities  of  water.  When  a 
few  ounces  only  were  present,  metallic  tinkling 
"was  tiniformly  produced,  but  when  two  quarts 
or  more  were  introduced,  a  bubbling  only  was 
heard,  without  metallic  resonance.  Similar  re- 
sults were  also  obtained  by  pouring  a  small 
stream,  or  letting  fall  drops  of  water  from  above 
upon  the  liquid  in  the  chest. 

EXPERIMENT  IV.  —  Succussion  and  percus- 
sion were  both  found  to  produce  the  same  me- 
tallic sounds  in  the  dead  body  as  during  life  in 
Case  II.  Metallic  sounds  elicited  by  percussion 
somewhat  resemble  those  occasionally  yielded 
by  the  heart,  and,  as  has  been  observed  by 


EXPERIMENTS.  227 

Bouillaud,  these  may  be  imitated  by  percussing 
the  back  *of  the  hand  pressed  closely  upon  the 
ear,  or  by  closing  both  ears  with  the  palms  of 
the  hands,  and  walking  on  a  carpet  in  a  still 
room. 

EXPERIMENT  V.  —  In  the  body  of  a  person 
recently  dead  from  accident,  having  no  pneumo- 
thorax,  a  repetition  was  made  of  several  of  the 
foregoing  trials.  Air  and  water  were  forced 
into  the  chest,  the  former  so  as  to  distend  the 
cavity  and  render  percussion  quite  resonant. 
Ebullition  of  the  fluid  was  then  produced  by 
blowing  through  a  tube  inserted  between  the 
ribs  and  pushed  below  the  surface.  The  only 
result  was  a  bubbling  noise,  having  not  the 
slightest  metallic  character.  It  will  be  observed 
that  this  was  nearly  a  repetition  of  Magendie's 
experiment,  and  it  probably  failed  to  produce 
metallic  sound  for  the  same  reason  as  in  that 
case,  viz.  that  the  patient  was  not  pneurnotho- 
racic. 

EXPERIMENT  VI.  —  A  bladder,  and  afterwards 
a  stomach,  each  containing  a  few  ounces  of 
water,  were  inflated  until  thoroughly  distended. 
Whenever  the  inflating  tube  was  pushed  below 


228  CASES    OF    PNEUMOTHORAX. 

the  surface  of  the  liquid,  and  the  inflation  con- 
tinued so  as  to  produce  bubbles,  a  sharp  tink- 
ling was  heard  upon  the  explosion  of  every 
bubble,  by  the  ear  applied  as  in  ausculting  to 
the  outside  of  the  bladder.  In  this  experiment 
the  sound  becomes  more  exquisitely  metallic,  in 
proportion  as  the  tension  of  the  bladder  is  in- 
creased by  farther  inflation.  Succussion  of  the 
bladder  produces  a  similar  effect.  It  is  neces- 
sary that  a  recent  bladder  should  be  used,  the 
texture  and  elasticity  of  which  are  not  altered 
by  drying.  When  the  orifice  of  the  tube  is 
above  the  surface  of  the  water,  also  when  no 
water  is  present  in  the  bladder,  an  intense  am- 
phoric sound  is  produced  during  inflation ;  and 
if  saliva  or  other  liquid,  in  small  quantities,  is 
blown  through  the  inflating  tube,  a  more  feeble, 
or  submetallic  tinkling  is  produced. 

From  the  foregoing  experiments  and  cases, 
we  may  infer  that  the  following  agencies  are 
concerned  in  producing  metallic  sounds  of  the 
chest. 

\.  There  must  be  a  cavity,  the  walls  of  which 
are  preternaturally  susceptible  of  vibration. 


REMARKS.  229 

This  takes  place  when  the  pleura  is  pathologi- 
cally distended,  so  as  to  overcome  the  obtuse  or 
muffling  effect  of  the  contiguous  soft  organs, 
such  as  the  lung,  diaphragm  and  intercostal 
muscles.  Some  time  is  probably  necessary  to 
prepare  the  parts  for  this  pathological  resonance, 
since  it  fails  to  appear  post  mortem  in  healthy 
chests  submitted  to  experiment.  It  should  be 
added,  that  when  metallic  sounds  appear  in 
simple  phthisis,  there  are  cavities  of  the  lungs, 
the  walls  of  which  are  in  a  state  of  tubercular 
induration. 

2.  The  immediate  or  exciting  cause  of  metal- 
lic tinkling,  is  a  forcible  or  sudden  disturbance 
of  the  liquid  in  a  vibrating   cavity   like   that 
described.      The   explosion   of  bubbles   of  air 
from  beneath  the  surface  of  the  liquid,  appears 
to  be  the  most  common  cause  of  such  a  dis- 
turbance ;  but  it  may  also  take  place  when  a 
part  of  the  liquid  is  thrown  upward  in  the  act 
of  coughing  and  falls  back  upon  the  remainder. 
The  same  occurs  in  succussion  of  the  chest. 

3.  The  vibrations  which  yield  metallic  tink- 
ling are  transmitted  from  the  liquid  to  the  solid 
parietes,  and  thence  directly  to  the  ear,  without 


230  REMARKS    ON.  PNEFMOTH0RAX. 

any  necessary  agency  of  an  echo,  or  reverbera- 
tion of  air  in  the  cavity.  This  is  shown  partic- 
ularly by  the  experiment  of  the  bowl,  page  203. 

4.  A  minor,  or  submetallic  tinkling,  having  no 
musical  resonance,  may  be  produced  by  slight 
impulses  given  to  the  air  in  the  cavity,  such  as 
the  breaking  of  bubbles  of  mucus  at  orifices 
above  the  surface  of  the  liquid. 

5.  Amphoric  resonance  is  produced  by  rever- 
berations of  the  air  in  a  vibrating  cavity,  with- 
out sonific  impulse  of  the  liquid.     The  same  is 
true  of  metallic  modifications  of  the  voice,  and 
of  the  cough  when  there  is  no  tinkling.     Metal- 
lic percussion  seems  also  to  depend  upon  the 
vibrations  of  air  independently  of  liquid,  and 
may  be  produced  in  some  other  cases  when  we 
strike  upon  a  tense  cavity  in  which  a  certain 
quantity  of  air  is  confined. 


ON 

THE  PHARMACOPEIA 

OF  THE 

UNITED  STATES  OF  AMERICA. 

[FROM  THE  AMERICAN  JOURNAL  OF  MEDICAL  SCIENCES  FOR  1831  ] 

IF  the  medical  and  scientific  world  were 
restricted  to  the  most  simple  modes  of  expres- 
sion and  inter-communication,  if  we  possessed, 
for  example,  but  one  nosology,  but  one  system 
of  natural  history,  but  one  language  of  chem- 
istry and  pharmacy,  it  is  obvious  that  the  books 
which  treat  of  those  sciences  would  be  greatly 
simplified;  that  the  labor  of  learners  would  be 
abridged,  and  much  confusion  prevented  among 
those  who  respectively  teach,  or  cultivate,  these 
departments  of  knowledge.  Of  this  fact  the 
public  are  so  well  aware,  that  attempts  have 


232 


ON    THE    PHARMACOPCEIA 


been  many  times  made  to  establish  in  these 
sciences  standards  of  definite  expression.  Some- 
times under  the  sanction  of  governments,  some- 
times from  the  influence  of  popular  writers  or 
teachers  in  science,  and  sometimes  from  the 
conventional  authority  of  delegated  bodies,  a 
common  language  has  been  introduced,  and 
obtained  a  degree  of  currency,  which,  though 
seldom  universal,  has,  nevertheless,  been  suffi- 
ciently extensive  to  produce  a  full  proof  and 
conviction  of  its  utility. 

Unhappily,  however,  in  those  studies,  the 
subjects  of  which  are  most  multifarious  and 
complex,  and  which  therefore  stand  most  in 
need  of  precision  in  their  nomenclatures,  an 
inexplicable  confusion  of  language  still  exists. 
Mineralogy,  zoology,  and  botany,  particularly 
the  two  latter,  in  themselves  no  trifling  subjects 
of  labor,  have  been  rendered  to  most  persons 
absolutely  insurmountable,  by  the  cumbrous 
load  of  synonyms,  which  has  been  gradually 
accumulating  upon  them,  under  the  agency 
of  successive  reformers.  The  Latin  language, 
once  the  common  medium  of  intercourse  for  the 
learned  of  all  countries,  has  itself  become  a  sort 


OF    THE    UNITED    STATES.  233 

of  Babel,  furnishing,  not  unfrequently,  a  dozen 
incongruous  names  for  the  same  object.  And 
since  neither  Napoleon  nor  Nicholas,  nor  any 
general  congress  for  the  pacification  of  Europe, 
has  taken  in  hand  the  reconciliation  of  conflict- 
ing terminologies,  the  republic  of  names  still 
remains  at  the  mercy  of  every  innovator  whose 
new  colors  may  attract  partisans  and  disciples, 
and  increase  the  anarchy  already  existing. 

It  is  therefore  sufficiently  evident,  that  the 
language  of  the  sciences  which  we  have  men- 
tioned, needs  retrenchment  quite  as  much  as 
extension ;  and  were  it  not  for  the  fact,  that 
certain  nomenclatures  have  become  incorpo- 
rated with  books  more  useful  than  themselves, 
it  would  be  a  happy  circumstance,  if  all  of 
them,  save  one,  could  be  consigned  to  oblivion. 
To  determine  what  one  in  each  particular  case 
should  supersede  all  the  rest,  might  be  as  deli- 
cate an  affair  as  to  elect  a  president  of  the 
United  States.  But  it  is  not  the  less  true,  that 
one,  even  though  deficient  and  unacceptable, 
would  be  far  better  than  many. 

Pharmacology,  considered  not  only  as  a  sci- 
ence, but  as  a  medium  of  communication  for 


234  ON    THE    PHARMACOPOEIA 

two  extensive  professions,  particularly  needs 
simplicity  and  precision  of  language.  It  like- 
wise requires  that  its  expressions  should  be 
generally  intelligible,  an  advantage  which  can- 
not be  secured,  except  by  the  introduction  of 
a  general  standard,  regulating  the  names  as 
well  as  the  selection  and  modification  of  its 
subjects.  On  this  ground,  it  is  presumed,  there 
is  no  variance  of  opinion.  But  when  we  arrive 
at  the  question,  what  the  standard  shall  be,  and 
who  shall  appoint  it,  the  charm  of  unanimity  is 
very  apt  to  dissolve. 

It  is  not  difficult  to  frame  a  competent  phar- 
macopoeia, which  shall  be  abundantly  adequate 
to  the  wants  of  the  medical  community.  But 
to  devise  a  plan  by  which  its  general  adoption 
shall  be  secured,  is  a  task  which  experience  has 
proved  to  be  attended  with  no  ordinary  diffi- 
culty. Local  partialities,  and  an  unwillingness 
to  receive  the  supposed  dictation  of  others, 
have,  in  more  cases  than  one,  frustrated  the 
best  contrived  plans  for  promoting  a  general 
accommodation.  And  since  indisputable  per- 
fection is  not  to  be  expected  in  a  pharmaco- 
peia, there  will  always  be  found  a  spirit  of 


OP    THE    UNITED    STATESr  23 

hypercriticism,  ready  to  consider  trivial  defects, 
as  reason^  for  rejecting  a  public  good.  • 

We  hold  it  to  be  a  maxim,  that  one  standard 
of  pharmacy,  if  sanctioned  throughout  a  whole 
country,  even  though  it  be  an  imperfect  one,  is 
far  more  promotive  of  public  convenience  than 
a  number  of  more  learned  and  perfect  ones 
existing  simultaneously.  The  late  autocrat,  Al- 
exander, ordered  his  Scotch  body-surgeon,  Sir 
James  Wylie,  to  prepare  a  Pharmacopeia  Ros- 
sica,  which  he  introduced  by  an  ukase  through- 
out his  extensive  dominions.  This  work,  a 
copy  of  which  has  reached  us,  appears  to  be 
sufficiently  respectable.  But,  without  entering 
into  its  particular  merits  or  demerits,  we  will 
venture  to  presume  that  the  subjects  of  his 
hyperborean  majesty  have  been  enabled  to  com- 
pound and  swallow  their  drugs  with  equal  effect, 
and  far  less  trouble,  than  those  of  the  king  of 
Grat  Britain,  speaking  in  the  tongues  of  three 
different  colleges. 

If  the  business  of  making  a  pharmacopeia 
could  be  commenced  do  novo,  without  reference 
to  any  of  the  standards  now  existing,  the  great 
question  presented  with  regard  to  nomenclature 


236 


ON    THE    PHARMACOPOEIA 


would  be,  whether  names  should  be  scientific, 
that  is,  in  some  measure  descriptive  of  the 
origin,  character,  and  composition  of  medicines ; 
or  whether  they  should  be  arbitrary,  having  no 
such  reference  or  import.  In  the  former  case, 
the  names  would  be  more  expressive,  and  better 
suited  to  the  dignity  of  science ;  in  the  latter 
they  would  be  more  permanent,  from  not  being 
connected  with  any  fluctuating  medium. 

To  illustrate  these  positions,  let  us  observe 
the  revolution  through  which  a  single  substance 
has  been  obliged  to  pass,  in  order  to  keep  pace 
with  the  progress  and  improvements  of  science. 
Since  the  discovery  of  calomel,  that  article  has 
been  reformed  by  at  least  a  score  of  successive 
appellations.  In  the  figurative  language  of  al- 
chemy it  was  known  by  the  names  of  draco 
mitigatus,  aquila  alba,  manna  metallorum,  &c. 
As  chemistry  grew  somewhat  more  definite  as 
a  science,  this  substance  became  mercurius  dul- 
cis,  and  mercurius  dulcis  sublimatus.  Under 
the  regime  of  Lavoisier  and  his  cotemporaries, 
it  was  a  muriate  and  a  submuriate ;  and  after 
Davy  and  Gay  Lussac,  became  a  chloride  and 
a  proto-chloruret.  Lastly,  as  if  the  gentleness 


OF    THE    UNITED    STATES.  237 

of  its  character  was  to  produce  a  reconcilia- 
tion of  extremes,  the  mitigated  dragon  of  anti- 
quity has  become  a  mild  chloride  of  mercury. 

On  the  other  hand,  when  a  nomenclature  has 
been  perfectly  arbitrary  and  divested  of  scien- 
tific relations,  it  has  been  proportionally  dura- 
ble and  constant.  Like  the  words  engrafted  on 
a  national  language,  its  origin  may  be  vague 
and  accidental,  yet  the  public  convenience  pre- 
vents it  from  falling  into  disuse ;  and  though 
it  might,  perhaps,  be  susceptible  of  reform,  yet 
the  benefit  would  not  compensate  the  trouble. 
In  regard  to  pharmacology,  there  is  one  lan- 
guage alone  which  has  remained  permanent 
amidst  mutations,  and  which  a  hundred  years 
have  not  been  able  to  shake  from  its  basis  — 
we  mean  the  language  of  commerce.  This 
language,  which  is  for  the  most  part  arbitrary 
and  accidental,  has  seen  many  pharmacopoeias 
rise  and  fall,  and  is  now  quite  as  likely  as  any 
one  of  them  to  last  for  a  century  to  come. 
The  simple  names  of  opium  and  alum,  of  calo- 
mel and  camphor,  have  never  yielded  to  any 
periphrastic  method  of  expressing  the  same 
things.  Corrosive  sublimate  refuses  to  be  mod- 


238  ON    THE    PHARMACOPEIA 

ernized,  and  the  salts  of  Epsom  and  Rochelle 
maintain  their  ground  against  all  chemical  in- 
terference. The  combined  learning  of  two  hem- 
ispheres is  unable  to  prevail  against  copperas 
and  cream  of  tartar,  and  the  manufacturer  and 
me'rchant  still  continue  to  make,  sell  and  buy 
their  tartar  emetic  without  troubling  themselves 
to  inquire  whether  it  is  a  '  tartrate,'  or  a  '  cream 
tartrate,'  or  neither.  Nay,  in  some  instances 
the  vulgar  appellations  have  turned  the  tables 
upon  the  classical  and  scientific,  and  the  homely 
name  of  potash  has  dictated  to  the  learned  their 
more  elegant  potass  and  potassium. 

To  combine  in  practice  the  expressiveness 
and  precision  of  one  language  with  the  dura- 
bility of  the  other,  though  very  desirable,  Would, 
from  the  nature  of  the  subject,  be  impossible. 
Yet  an  approach  may  be  made  to  the  advan- 
tages of  both,  by  adopting,  in  the  first  instance, 
a  descriptive  language  founded  on  the  existing 
state  of  science  at  the  time,  and  afterwards  to 
declare  it  perpetual,  or  at  least  to  establish  it 
in  force  during  a  long  term  of  years.  We  should 
thus  possess  a  medium  of  communication  in 
itself  entitled  to  respect,  and  rendered  more 
valuable  by  the  prospect  of  being  permanent. 


OF    THE    UNITED    STATES.  239 

It  appears  to  us,  that  the  stability  of  pharma- 
ceutical language  is  a  consideration  of  quite  as 
much  importance  as  its  improvement.  Great 
changes,  in  regard  to  any  prevalent  system,  can 
seldom  be  effected  without  doing  violence  to 
established  habits  and  preferences  of  the  com- 
munity. An  apothecary,  whose  drawers  are 
labelled  with  the  legitimate  nomenclature  of 
the  day,  and  a  physician,  who  for  a  score  of 
years  has  employed  a  uniform  phraseology  in 
his  prescriptions,  are  not  compensated  by  any 
trifling  advantage,  for  the  risk  and  trouble  of 
an  entire  change.  Wherever,  therefore,  it  ap- 
pears that  a  uniform  system  is  extensively  es- 
tablished in  any  country,  it  is  incumbent  on 
the  friends  of  science  to  oppose  all  unnecessary 
deviation  from  the  rules  it  prescribes.  If  the 
general  progress  of  other  sciences  has  been  such 
as  to  require  that  pharmacy  should  be  made  to 
keep  pace  with  them,  its  improvement  ought  to 
consist  as  far  as  possible  in  additions,  syno- 
nyms, and  commentaries,  but  not  in  great  or 
violent  changes.  It  is  fortunate  for  the  science 
of  anatomy  that  its  distinctive  names  have 
been  handed  down  from  one  generation  to  an- 


240  ON    THE    PHARMACOPOEIA 

other  with  so  little  alteration ;  and  we  believe 
no  reformer  at  the  present  day  would  obtain 
many  proselytes,  who  should  propose  to  abolish 
its  nomenclature,  because  pia  mater,  os  sacrum, 
ossa  innominata,  and  similar  names  are  absurd, 
misplaced,  or  unscientific. 

In  regard  to  preparations  and  compositions? 
it  may  often  happen  that  improvements  are 
necessary  in  pharmacy,  to  promote  the  economy 
and  uniformity  of  certain  results.  Such  changes 
are  highly  proper,  provided  they  do  not  interfere 
materially  with  the  standard  of  strength  which 
has  been  previously  current.  But  great  changes 
in  the  strength  of  medicines  may  generally  be 
regarded  as  pernicious,  serving  to  perplex  apoth- 
ecaries and  deceive  physicians,  if  not  to  kill 
patients.  It  is  to  be  regretted  that,  in  the  dif- 
ferent pharmacopoeias  which  have  been  pub- 
lished among  us,  there  are  operative  medicines 
bearing  the  same  name,  in  some  of  which  the 
strength  is  double  that  of  others.  As  to  the 
more  complex  medicinal  formulae  which  crowd 
our  books,  it  will  be  found  that  most  of  them 
owe  their  place  in  the  shops  to  some  fashion,  or 
some  traditional  celebrity,  rather  than  to  any 


OF    THE    UNITED    STATES.  241 

exclusive  fitness  or  virtue ;  and  we  may  perhaps 
get  a  true  idea  of  their  value  from  the  consid- 
eration, that  if,  by  any  means,  the  knowledge 
of  the  whole  of  them  should  be  lost,  it  is  not 
probable,  in  the  doctrine  of  chances,  that  one  in 
fifty  would  ever  be  reinvented.  Yet,  since  the 
prevailing  traffic  requires  that  they  should  con- 
tinue to  be  made  and  sold,  it  is  important  for 
those  who  consume  them,  that  they  should  be 
exempt  from  fluctuations  of  character. 

In  the  United  States,  previous  to  1820,  there 
was  no  uniformity  of  pharmaceutical  language. 
Pharmacopoeias,  indeed,  had  been  adopted  by 
medical  bodies,  in  Massachusetts  and  some 
of  the  other  States ;  and  Dispensatories,  both 
foreign  and  native,  had  been  published  among 
us.  But  in  the  year  referred  to,  an  effort  was 
made,  by  which  the  consent  of  a  great  majority 
of  the  medical  institutions  of  the  country  was 
obtained,  for  a  plan  of  a  national  pharmaco- 
poeia. This,  it  was  confidently  hoped,  by  intro- 
ducing a  current  language  throughout  the  coun- 
try, would  do  away  the  confusion  which  then 
prevailed,  and  offered  to  the  parties  concerned  a 
facility  of  intercommunication,  corresponding  to 
16 


242  ON    THE    PHARMACOPOEIA 

that  which  results  from  a  common  system  of 
coinage,  or  of  weights  and  measures.  A  nu- 
merous and  highly  respectable  delegation  was 
appointed,  from  most  of  the  principal  States,  a 
part  of  whom  met  in  the  city  of  Washington, 
at  the  appointed  time. 

It  may  here  be  proper  to  inquire  what  such  a 
convention  could  reasonably  be  expected  to  do, 
and  what  it  was  their  duty  to  do,  under  the  cir- 
cumstances in  which  they  were  placed.  Com- 
ing together  from  remote  places,  and  holding 
their  session  at  an  inconvenient  sacrifice  of  time 
and  expense,  it  was  not  to  be  anticipated  that 
they  would  institute  an  original  investigation  of 
the  whole  subject.  The  ordeal  of  an  experi- 
ment upon  every  doubtful  subject,  would  have 
involved  a  labor  of  months,  and  perhaps  of 
years.  It  would  not  reasonably  be  expected 
that  they  would  produce  a  pharmacopoeia, 
which  should  be  better  than  any  which  pre- 
viously existed.  A  debating  assembly  would 
be  far  less  likely  to  do  this,  than  a  competent 
individual  in  his  closet.  Yet  the  convention 
possessed  the  power  to  confer  a  great  good ;  a 
power  which  no  individual  is  likely  to  obtain, 


OF    THE    UNITED    STATES.  243 

that  of  introducing  order  in  the  place  of  con- 
fusion, and  law  instead  of  anarchy. 

Under  these  circumstances,  it  was  incumbent 
on  them  to  produce,  or  sanction,  some  standard 
of  pharmacy  which  should  be  adequate  to  the 
wants  of  the  community.  It  was  not  very 
material  what  one,  among  many  standards, 
they  should  adopt  as  their  basis.  They  might 
have  selected  the  Edinburgh  Pharmacopoeia, 
which,  though  prolix  in  its  expressions,  was  at 
that  time  more  current  than  any  other  in  the 
country.  Or  they  might  have  taken  the  London 
Pharmacopoeia,  dogged  as  it  has  been  by  Mr. 
Phillips,  and  this  would  have  served  very  well 
as  the  groundwork  of  a  useful  book.  Or  they 
might  endeavor  to  frame  a  system  of  their  own, 
which,  in  some  respects,  might  be  superior  to 
its  predecessors,  or  at  least  better  adapted  to 
the  customs  and  wants  of  owe  own  country. 
The  last  plan  was  decided  on  by  the  conven- 
tion, under  the  expectation,  doubtless,  that  it 
would  be  more  acceptable  to  their  constituents. 
A  programme  of  a  pharmacoposia  prepared  by 
the  College  of  Physicians  in  Philadelphia,  was 
adopted  as  the  groundwork,  and,  after  being 


244  ON    THE    PHARMACOPO3IA 

variously  modified  and  augmented,  was  referred 
to  a  committee,  with  instructions  to  publish  it. 

It  must  necessarily  happen  that  a  work  ema- 
nating from  so  many  disconnected  sources,  a 
part  of  whose  contents  must,  from  the  nature 
of  the  case,  be  the  result  of  compromise  among 
the  parties  concerned,  rather  than  of  satisfac- 
tion to  any  of  them,  would  be  in  some  respects 
imperfect,  disconnected,  and  redundant.  Nev- 
ertheless, if  it  was  on  the  whole  better  suited 
to  the  occasion  than  any  other  work  actually 
existing,  the  public  were  bound  to  receive  it 
with  complacency,  as  the  only  standard  which 
could  ever  become  general  among  us.  And  if 
criticisms  were  needed  to  point  out  the  faults 
which  it  contained,  they  should  have  been 
made  in  a  spirit  of  manliness  and  liberality, 
such  as  would  have  promoted  the  gradual  re- 
form and  perfection,  rather  than  the  over- 
throw of  the  work.  But  several  of  the  journals 
thought  otherwise,  and  the  pharmacopeia  was 
obliged  to  undergo  an  ordeal,  the  severity  of 
which  far  exceeded  its  deserts.  The  spirit  of 
criticism  was  pushed  with  a  zeal  not  according 
to  knowledge,  and  in  many  instances  the  igno- 


OF    THE    UNITED    STATES.  245 

ranee  of  the  commentator,  rather  than  the  de- 
fects of  the  book,  produced  a  reprobation  of  its 
contents.  Nevertheless,  the  pharmacopoeia  was 
received,  willingly  by  some,  and  reluctantly  by 
others,  and  became,  we  have  reason  to  believe, 
the  prevailing  standard,  or  at  least  more  preva- 
lent than  any  other  throughout  the  United 
States. 

It  was  to  be  hoped  that,  when  the  period 
should  arrive  which  had  been  assigned  by  the 
convention  for  a  revision  of  this  work,  a  suffi- 
cient unanimity  of  sentiment  would  have  pre- 
vailed, to  direct  into  one  channel  whatever 
amount  of  skill  and  experience  might  be  vol- 
unteered for  its  improvement,  either  by  socie- 
ties or  individuals.  It  appears  that  numerous 
societies,  in  different  parts  of  the  Union,  feeling 
an  interest  in  the  revision  and  confirmation  of 
the  pharmacopoeia,  had  appointed  delegates  to 
attend  the  expected  convention  at  Washington, 
in  1830.  A  part  of  the  delegates  thus  desig- 
nated were,  agreeably  to  the  provisions  made  in 
1820,  returned  to  the  presiding  officer  of  that 
year.  But  a  greater  number,  who  had  not  been 
formally  returned,  proceeded  to  Washington  at 


246  ON    THE    PHARMACOPOEIA 

the  appointed  time,  and  having  organized  a 
convention  of  such  delegates  as  were  present, 
and  invited  a  cooperation  of  other  medical  gen- 
tlemen of  eminence  then  in  the  city,  proceeded 
to  take  measures  for  the  republication  of  the 
work.  In  the  mean  time,  a  part  of  the  delegates 
who  had  been  officially  returned  to  the  former 
president,  influenced  either  by  convenience,  or 
by  the  smallness  of  their-  numbers,  determined 
not  to  convene  at  Washington,  but  held  a  meet- 
ing in  New  York,  where  they  also  proceeded 
to  take  measures  for  republishing  the  pharma- 
copoeia, having  likewise  invited  the  cooperation 
of  other  medical  gentlemen  of  note.  Out  of 
this  want  of  concord  have  risen  up  two  phar- 
macopoeias, neither  of  which  can  strictly  claim 
to  be,  by  lineal  descent,  the  legitimate  heir  of 
the  original  work  ;  one,  proceeding  from  a  body 
not  formally  declared  elected  to  the  convention 
at  Washington ;  the  other,  from  a  body  who  did 
not  convene  at  Washington  at  all.  We  regret, 
during  the  long  period  of  preparation,  in  which 
the  proceedings  of  each  party  must  have  been 
known  to  the  other,  at  least  in  a  degree,  that 
some  compromise  was  not  effected,  so  that  the 


OF    THE    UNITED    STATES.  247 

objects  of  both  might  be  effected,  with  less 
trouble  to  themselves,  and  less  expense  to  the 
public.  It  was  not  indeed  in  the  power  of  the 
delegates  at  "Washington  to  correct  the  original 
defect  in  their  mode  of  election,  but  it  was  in 
the  power  of  the  delegates  of  New  York  to 
have  gone  to  Washington,  and  there  to  have 
invited  the  cooperation  of  the  other  delegates 
present,  especially  as  they  appear  not  to  have 
been  afterwards  fastidious  in  associating  with 
their  own  body  undelegated  individuals.  Even 
after  the  original  meetings  had  taken  place,  a 
slight  spirit  of  conciliation  in  one  or  both  par- 
ties, (we  know  not  which  was  wanting  in  this 
respect,)  would  have  produced  harmony  and 
unity  in  the  end. 

As  things  now  are,  it  appears  to  us  that  the 
two  works  must  stand  upon  their  respective 
merits,  as  pharmaceutic  compositions ;  and  the 
public  are  called  on  to  decide  whether  either, 
and  if  either,  which  one,  is  entitled  to  be  re- 
ceived as  the  national  standard.  And  here,  if 
it  be  asked  what  constitutes  fitness  or  excel- 
lence in  a  pharmacopoeia,  we  should  answer 
simply,  that  such  a  work  ought  to  contain  and 


248  ON    THE    PHARMACOPCEIA 

identify  the  medicines  which  are  commonly 
used  by  physicians,  that  its  preparations  should 
be  scientifically  composed,  that  its  language 
should  conform  to  the  most  current  language 
of  the  day,  and  that  it  should  be  complete  as 
a  system  in  itself,  that  is-,  should  have  a  cor- 
respondence between  its  own  parts.  In  these 
respects,  we  think  the  Washington  Pharma- 
coposia  has  greatly  the  advantage  of  its  com- 
petitor. We  observe  in  its  list  of  materia  med- 
ica,  comparatively  few  alterations  of  names, 
and  these  are  made  mostly  in  conformity  to  the 
present  language  of  chemistry.  In  the  New 
York  edition  the  changes  are  exceedingly  nu- 
merous, the  new  names  being  taken  partly  from 
the  London  Pharmacopoeia,  and  partly  invented 
for  the  occasion,  so  that  the  book  has  the  aspect 
of  an  edition  of  some  other  work,  rather  than  of 
the  American  Pharmacopoeia.  The  references 
to  authors,  which  are  considered  necessary  by 
most  pharmacologists,  to  identify  the  substances 
intended,  are  wholly  omitted  in  this  work.  In 
regard  to  completeness  and  accuracy,  the  work 
of  the  Washington  convention  is  prepared  with 
much  care  and  science,  and  with  a  correspond- 


OF    THE    UNITED    STATES.  249 

ence  of  its  different  parts.  In  the  New  York 
edition  we  find  a  want  of  unity,  such  as  attends 
hasty  preparations,  and  a  discordance  often 
recurring  between  the  names  of  the  articles 
themselves  and  those  of  their  preparations. 

In  regard  to  the  latter  work,  knowing  the 
difficulties  which  attend  this  species  of  compo- 
sition, and  entertaining  a  high  respect  for  the 
character  of  the  gentlemen  concerned,  we  for- 
bear to  fill  our  pages  with  commentaries  on  its 
redundancies  and  discrepancies.  We  shall  not 
therefore  complain  because  Burgundy  pitch  is 
inserted  twice  under  different  names,  in  the 
materia  medica,  nor  because  the  sulphates  of 
quinine  and  morphine,  figs,  prunes,  and  some 
other  articles  required  in  the  preparations,  are 
not  inserted  in  the  materia  medica  at  all.  These 
things  must  be  corrected  with  their  pens,  by 
those  who  may  employ  the  book.  On  the  other 
hand,  we  are  happy  to  perceive  some  improve- 
ments on  the  edition  of  1820,  in  the  greater 
accuracy  of  the  chemical  nomenclature,  and  in 
the  introduction  of  some  useful  formulas.  We 
think  however  that  retrenchment,  in  the  old 
work,  was  much  more  needed  than  augmenta- 
tion. 


250  ON    THE    PHARMACOPOEIA 

Believing  that  the  pharmacopoeia  produced 
by  the  Washington  convention,  being  a  more 
elaborate,  accurate,  and  finished  work,  will 
eventually  become  the  standard  of  the  country, 
we  propose  to  enter  somewhat  more  at  large 
into  the  consideration  of  its  contents.  This  we 
shall  endeavor  to  do  with  the  impartiality  which 
the  subject  ought  to  receive. 

In  their  preface  this  convention  express  their 
reasons  for  adopting  as  their  basis  the  Phar- 
macopoeia of  1820,  a  work  having  many  incon- 
veniences and  defects,  but  at  the  same  time 
many  claims  to  approval.  In  its  general  out- 
line, say  they,  and  prominent  features,  it  will 
bear  a  favorable  comparison  with  the  best  phar- 
macopoeias of  Europe,  and  it  is  only  in  filling 
up,  that  improvement  is  demanded,  or  admis- 
sible. The  changes  therefore  which  have  been 
made  under  the  authority  of  the  late  conven- 
tion, embrace  the  materials  and  minor  arrange- 
ments, without  extending  to  the  general  plan. 
In  preparing  for  the  press  the  present  revised 
edition,  the  new  convention  inform  us  that 
much  labor  has  been  expended,  and  every  part 
of  the  work  submitted  to  the  most  strict  and 


OF    THE    UNITED    STATES.  251 

rigid  scrutiny.  Every  accessible  pharmaceutic 
authority  has  been  consulted,  and  the  accuracy 
of  processes  has  been  frequently  tested  by  a 
practical  investigation  ;  the  several  departments 
have  engaged  the  attention  of  individuals  pe- 
culiarly qualified  by  their  previous  studies,  and 
the  whole  has  passed  the  examination  of  phar- 
maceutists of  acknowleged  eminence  in  their 
profession. 

Considering  how  difficult  it  is  to  induce  per- 
sons of  the  necessary  competency  to  engage  in 
gratuitous  labors  with  perseverance  and  fidelity, 
we  are  happy  that  the  individuals  concerned  in 
the  present  revision  have  devoted  themselves 
with  such  singleness  of  purpose  to  the  perfect- 
ing of  the  work.  From  our  knowledge  of  the 
amount  of  labor  actually  bestowed  on  it,  and 
from  the  internal  evidences  which  it  bears  of 
extensive  inquiry  and  precise  examination,  we 
doubt  whether  any  future  convention  will  pre- 
sent us  with  results  more  deserving  of  the 
public  confidence. 

In  pursuance  of  the  plan  of  the  former  edi- 
tion, and  for  reasons  which  it  is  not  necessary 
here  to  repeat,  the  pharmacoposia  is  written  out 


252  ON    THE    PHARMACOPOEIA 

on  opposite  pages  in  Latin  and  in  English. 
The  classical  latinity  of  the  London  Pharma- 
copoeia is  adopted  as  a  standard,  and,  by  keep- 
ing this  in  view,  a  unity  of  style  is  preserved 
throughout  the  book.  We  see  no  cause  to  be 
dissatisfied  with  the  general  purity  and  ele- 
gance of  this  language,  though  in  one  case,  we 
observe,  the  convention  have  erroneously  fol- 
lowed the  London  example,  in  using  the  geni- 
tive 'rosmarini,'  and  ablative  'rosmarino,'  in- 
stead of  the  undoubted  rorismarini,  and  rore- 
marino,  sanctioned  by  Horace,  Columella,  and 
other  classics. 

In  regard  to  names,  .the  convention  informs 
us  in  their  preface,  that  for  reasons  which  they 
discuss  at  length,  they  have  adopted  the  mod- 
ern chemical  nomenclature,  in  which  the  names 
are  expressive  of  the  composition  of  bodies. 
This  was  in  most  cases  done  by  the  framers 
of  the  former  pharmacopoeia,  but  in  the  present 
edition  an  attempt  has  been  made  to  bring  the 
nomenclature  more  completely  in  accordance 
with  the  best  scientific  usage.  Thus  we  have 
chloride  of  sodium,  instead  of  muriate  of  soda ; 
ferrocyanate  of  iron,  instead  of  prussiate  of  iron, 


OF    THE    UNITED    STATES.  253 

&c.  In  a  few  instances,  however,  to  avoid  great 
circumlocution,  a  pharmaceutical  name  is  re- 
tained in  the  place  of  a  more  expressive  chemi- 
cal appellation,  as  in  the  case  of  alumen,  hy- 
drargyrum, ammoniatum,  &c.  In  conformity 
with  the  present  language  of  chemistry,  the 
proportional  composition  of  bodies,  it  appears, 
is  intended  to  be  expressed,  and  we  have, 
among  other  things,  a  bicarbonate  of  potass, 
and  a  bicarbonate  of  soda.  But  this  intention 
is  not  always  executed  throughout  the  work, 
which  seems  to  us  a  defect  in  uniformity.  The 
substance  called  by  this  convention  sulphate  of 
copper  is  a  bisulphate,  and  ought  so  to  be 
called  in  a  chemical  nomenclature,  since  there 
is  another  sulphate,  composed  of  one  equivalent 
of  acid  and  one  of  peroxide  of  copper,  which 
is  precipitated  by  adding  pure  potass  to  the 
solution  of  the  bisulphate  above  mentioned,  in 
a  quantity  insufficient  for  separating  the  whole 
of  the  acid. 

We  know  not  for  what  reason  it  has  been 
thought  proper  to  omit,  as  synonyms,  certain 
commercial  names  of  common  usage,  while 
others,  of  much  less  frequent  occurrence,  are 


254  O1S    THE    PHARMACOPO3IA 

retained.  The  student  of  pharmacy  who  would 
know  what  is  meant  by  Epsom  salt,  Glauber's 
salt,  blue  vitriol,  and  other  names  which  meet 
him  in  the  daily  price  current,  must  seek  for 
information  in  other  books  than  the  American 
Pharmacopeia.  These  names  being  interna- 
tional and  long  established,  cannot,  we  think, 
with  propriety,  be  given  up  in  a  work  of  general 
pharmacy. 

In  the  nomenclature  of  substances  derived 
from  the  vegetable  kingdom,  the  work  before 
us  adheres  to  the  simple  and  appropriate  plan 
of  the  first  edition,  that  of  using,  in  all  practi- 
cable cases,  a  single  word  for  the  name  of  the 
drug,  leaving  its  nature  and  origin  to  be  de- 
fined in  the  opposite  column.  This  peculiarity 
of  the  American  Pharmacopoeia  is  one  of  its 
leading  excellences,  and  one  which  the  New 
York  convention  seem  to  have  acted  unwisely 
in  abandoning.  Most  of  the  names  used  in 
other  pharmacopeias,  to  express  vegetable  sub- 
stances, are  either  unwieldy  in  their  length,  or 
improper  in  their  application.  Thus  the  drug 
assafoetida  is  called  by  the  Edinburgh  college 
gummi  resina  ferulae  assafcetidae,  a  name  which 


OF    THE    UNITED    STATES.  255 

is  highly  descriptive,  but  inapplicable  to  com- 
mon use.  By  the  London  college  it  is  called 
assafoetidae  gummi  resina ;  but  as  the  term  as- 
safoetida  alone  is  not  the  name  of  any  plant, 
in  any  botanical  system  of  the  present  day, 
the  whole  name  is  incorrectly  composed.  The 
,  simple  name  of  the  drug,  assafoetida,  is  un- 
doubtedly better  than  either.  In  like  manner 
columbo  may  be  called  by  the  simple  name 
colomba,  or  by  the  circuitous  name  cocculi 
palmata  radix,  but  not  calumbse  radix,  for  there 
is  no  such  plant  as  calumba.  The  American 
Pharmacopoeia  has  another  advantage  in  using 
simple  names,  whenever  the  drug  happens  to  be 
derived  from  several  plants,  as  camphor,  senna, 
rheum,  and  aloe,  or  from  several  animals,  ich- 
thyocolla.  In  the  present  edition,  a  slight  vari- 
ation is  made  from  the  former,  in  using  the 
Latin  name  of  the  article  always  in  the  singular 
number,  as  cantharis,  caryophyllus,  prunum, 
instead  of  cantharides,  &c.  This  method  pre- 
serves uniformity,  and  is  supported  by  the 
usage  of  Celsus  in  similar  cases. 

As  in  the  former  edition,  the  materia  medica 
list  is  divided   into  two   columns,  the  first  of 


256  ON    THE    PHARMACOPOEIA 

which  contains  the  officinal  name  of  each  ar- 
ticle, in  Latin  and  English,  together  with  oc- 
casional synonyms,  while  the  other  defines  the 
substance  intended,  and  gives  explanatory  ref- 
erences. This  part  of  the  work  gives  evidence 
of  a  laudable  degree  of  care  and  research,  yet 
we  notice  a  few  minor  things  deserving  of  re- 
mark. The  substance  called  lupulin,  derived 
from  the  hop,  is  defined  '  strobilorum  pollen.' 
As  the  word  pollen  has,  in  vegetable  physi- 
ology, a  specific  meaning,  it  would  have  been 
better  to  have  used  some  other  name  to  ex- 
press powder.  In  the  Latin,  lupulia,  as  used 
by  the  New  York  convention,  is  more  conso- 
nant to  morphia  and  quinia  than  lupulina.  We 
see  no  reason  for  giving  up  spermaceti,  the 
universally  received  name,  both  in  chemistry 
and  commerce,  and  substituting  cetaceum  of  the 
London  college,  a  word  which  is  neither  more 
classical,  nor  more  definitive.  Scabious,  applied 
to  erigeron,  is  a  provincial  misnomer,  that  name 
belonging  only  to  scabiosa. 

In  regard  to  preparations,  the  convention 
considering  this  the  most  extensive  and  impor- 
tant part  of  the  work,  have  devoted  to  it  a 


OF    THE    UNITED    STATES.  257 

greater  share  of  their  attention.  They  inform 
us  that  examination  has  been  carried  into  all 
its  parts,  and  not  a  single  process  has  been 
allowed  to  escape  a  close  scrutiny.  One  of  the 
most  prominent  defects  of  the  original  phar- 
macopoeia was  a  want  of  uniformity,  both  in 
the  manner  of  conducting  the  processes,  and  in 
the  style  of  describing  them.  This  arose  from 
the  variety  of  sources  from  which  materials 
were  drawn,  and  the  want  of  due  time  to  re- 
mould and  shape  them,  so  as  to  produce  a 
harmonious  whole.  In  the  present  edition  an 
effort  has  been  made  to  supply  these  deficien- 
cies, and  to  produce  uniformity  of  language,  as 
well  as  correspondence  and  unity  of  design,  in 
the  different  parts  of  the  work.  In  the  selection 
of  the  process  for  each  preparation,  two  princi- 
ples are  stated  to  have  governed  the  choice  of 
formulse,  independent  of  their  intrinsic  merit, 
which,  when  superior,  has  always  been  allow- 
ed a  predominating  influence.  When  two  or 
more  methods  of  preparing  the  same  compound, 
equally  meritorious  in  themselves,  have  come 
under  consideration,  that  has  been  preferred 
which  has  united  in  its  favor  the  widest  preva- 
17 


258 


ON    THE    PHARMACOPCEIA 


lence  in  this  country,  and  the  sanction  of  the 
majority  of  the  British  pharmacopeias.  It  is 
considered  highly  desirable,  that  uniformity  in 
the  preparation  of  medicines  should  everywhere 
prevail,  for  the  benefits  accruing  from  the  mu- 
tual interchange  of  the  medical  writings  of 
different  civilized  nations,  must  be  greatly  af- 
fected by  any  material  difference  in  the  nature 
or  composition  of  the  remedies  employed.  This 
remark  is  especially  applicable  to  Great  Britain 
and  the  United  States,  and  to  all  countries 
where  the  English  language  is  generally  used- 
It  is  a  duty,  therefore,  say  the  convention,  which 
we  owe  to  the  cause  of  pharmacy,  to  throw  our 
weight  into  the  scale  which  already  preponde- 
rates, and  thus  contribute  to  the  production 
and  maintenance  of  the  desired  uniformity. 

In  those  cases  where  the  chemical  formulae 
of  the  original  pharmacopoeia  have  been  found 
to  be  defective  or  objectionable,  their  place  has 
been  supplied  by  more  accurate  and  practicable 
rules,  founded  on  a  course  of  careful  investiga- 
tions. In  this  way  the  economy  and  uniformity 
of  certain  processes  is  greatly  promoted.  New 
preparations,  which  have  been  brought  to  light 


OF    THE    UNITED    STATES.  259 

by  the  uncommon  progress  of  pharmaceutic 
investigations,  during  the  last  dozen  years,  are, 
in  various  instances,  inserted.  Such  are  the 
preparations  of  iodine,  quinine  and  morphine. 
The  convention,  however,  have  shown  a  wise 
forbearance,  in  not  crowding  their  book  with 
the  host  of  new  articles,  often,  we  apprehend, 
more  curious  than  useful,  which  modern  chem- 
istry has  been  enabled  to  extort  from  vegetable 
drugs.  Retrenchment  has  been  freely  exercised 
in  lopping  off  many  of  the  superfluous  formu- 
las, which  a  necessity  for  hasty  compromise  had 
caused  to  be  introduced  into  the  pages  of  the 
old  pharmacopoeia ;  and,  among  other  articles 
dismissed  is  the  acetum  opii,  or  black  drop,  a 
revived  piece  of  antiquity,  wasteful  in  its  com- 
position, and  utterly  uncertain  in  its  strength, 
the  place  of  which  is  now  better  supplied  by 
the  acetated  tincture  of  opium,  and  the  acetate 
of  morphia.  For  ourselves,  by  the  way,  we 
lean  to  the  opinion,  that  opium,  to  produce  its 
full  benefit,  must  be  opium  still,  and  we  are 
not  sure  that  any  of  the  artificial  salts  of  mor- 
phia are  better  than  the  natural  meconate.  We 
have  seen  delirium  tremens  brought  on  under 


260  ON    THE    PHARMACOPEIA 

the  use  of  denarcotized  laudanum.  If  the  crude 
drug  were  cumbersome  from  the  bulk  necessary 
to  form  a  dose,  as  in  the  case  of  cinchona,  it 
would  be  highly  useful  to  reduce  its  active  in- 
gredient into  a  smaller  compass.  But  this  is 
not  the  case  with  many  of  the  narcotics. 

Very  complex  medical  formulas,  such  as 
abound  among  the  old  writers,  and  still  encum- 
ber the  pages  of  many  of  the  pharmacopoeias, 
we  deem  to  be  a  superfluous  appendage  to 
medical  science.  One  of  the  greatest  modern 
improvements  is  found  in  the  simplification  of 
medical  prescriptions.  The  art  of  prescribing 
appears  to  us  a  more  simple  affair  than  it  has 
been  represented  by  the  hypercritical  pedantry 
of  Dr.  Paris.  We  admit  that  adjuvants  will 
help,  and  that  corrigents  will  correct;  never- 
theless, we  find  that  castor  oil,  ipecac,  and 
opium  will  often  do  their  duty  without  either. 
In  admitting  the  influence  of  chemical  consid- 
erations in  the  exhibition  of  medicines,  it  is 
important  to  recollect  that  the  stomach  has  a 
chemistry  of  its  own,  and  that  the  digestive 
organs  exert  a  material  control  over  the  force 
of  ordinary  chemical  agents,  separating  ele- 


OF    THE    UNITED    STATES.  261 

ments  which  have  strong  mutual  attractions, 
and  dissolving  bodies  which  are  insoluble  in 
common  menstrua.  We  ought  by  no  means 
to  consider  medicines  inert  in  proportion  as 
they  are  insoluble,  for  we  have  a  proof  to 
the  contrary  in  calomel.  Nor  are  we  to  con- 
sider those  substances  medicinally  incompati- 
ble, which,  if  mixed  out  of  the  body,  occasion 
a  precipitate,  or  a  change  of  color.  What  in- 
compatible, we  would  ask,  destroys  the  effect  of 
opium,  strychnine,  or  cantharides  ? 

Another  consideration  which  has  great  weight 
with  writers  on  chemistry  and  pharmacy,  is  the 
exactness  and  precision  of  the  quantities  em- 
ployed in  their  preparations.  This  circum- 
stance, although  of  great  consequence  in  strict- 
ly chemical  compounds,  is  less  so  in  arbitrary 
mixtures ;  and  in  the  administration  of  simpler 
medicines  its  importance  diminishes  still  fur- 
ther. Practical  physicians  know,  that  a  degree 
of  accuracy,  approaching  nearer  than  within  a 
fifth  or  sixth  part  of  the  amount  desired  for 
producing  a  given  effect,  is  seldom  attainable. 
Apothecaries  divide  their  pills  and  powders  by 
the  eye,  and  patients  take  liquids  by  drops  and 


262  ON    THE    PHARMACOPEIA 

spoonfuls.  Nay,  that  physician  must  possess 
uncommon  shrewdness,  who,  even  after  appor- 
tioning his  dose  by  the  most  accurate  weight 
and  measure,  can  foretel  with  certainty  how 
or  when,  how  much  or  how  often,  it  is  going 
to  operate.  The  stomachs  of  different  patients, 
and  those  of  the  same  patient  at  different  times, 
vary  more,  if  possible,  than  the  samples  of  the 
same  drug  in  commerce. 

On  these  accounts  we  feel  but  little  concern 
for  the  changes  which  the  convention  have 
thought  proper  to  make  in  the  character  or 
strength  of  preparations  and  compositions,  so 
long  as  they  do  not  exceed  the  limits  above 
mentioned.  But  in  a  few  cases  we  observe 
that  the  strength  has  been  altered  in  the  pro- 
portion of  .two  to  one,  or  vice  versa,  and  of 
such  changes  we  propose  to  take  notice.  The 
vinum  antimonii,  which  in  the  old  edition  con- 
tained four  grains  to  the  fluid  ounce,  in  this 
edition  contains  but  two,  and  is  therefore  re- 
duced in  strength  one  half.  "We  object  to  this 
change,  because  the  stimulating  character  of  the 
menstruum  is  incompatible  with  the  indications 
for  which  antimony  is  generally  administered, 


OF    THE    UNITED    STATES.  263 

and  we  apprehend  that  a  glass  or  two  of  Tene- 
riffe  wine  would  do  no  good  to  a  man  in  apo- 
plexy or  incipient  fever.  The  wine,  indeed, 
ought  to  bear  as  small  a  proportion  as  possible 
to  the  operative  medicine,  and  if  the  London 
college  is  followed  in  lessening  the  proportion 
of  antimony,  it  should  also  have  been  followed 
in  diluting  the  wine  largely  with  water.  The 
vinegar  and  syrup  of  squill  are  increased  to 
twice  their  former  strength,  a  change  in  itself 
of  no  consequence,  when  the  public  shall  have 
learned  to  regulate  the  dose.  Liniment  of  am- 
monia is  reduced  to  one  quarter  of  its  former 
strength.  Can  this  preparation  ever  be  too 
strong  for  the  purposes  to  which  it  is  applied  ? 

In  a  work  so  generally  uniform  and  consen- 
taneous in  its  parts  as  the  American  Pharma- 
copoeia, we  would  willingly  have  dispensed 
with  such  names  as  pulvis  aromaticus  and 
pilulae  cathartics  composite.  These  names 
designate  nothing  that  is  not  common  to  a 
thousand  other  combinations. 

A  few  things  are  omitted  in  this  edition, 
which  we  would  have  willingly  seen  retained ; 
but  we  are  not  disposed  to  cavil  on  this  ac- 


264  ON    THE    PHARMACOPEIA 

count,  since  in  that  instance,  as  well  as  in  the 
case  of  objectionable  formulas,  the  evil  may 
generally  be  remedied  by  extemporaneous  pre- 
scription. Every  man  has  his  particular  taste 
and  judgment,  and  de  gustibus  non  disputan- 
dum.  In  the  wine  of  antimony,  to  which  we 
have  objected,  the  evil  is  remedied  by  extem- 
poraneous solutions  in  water,  which  are  far 
preferable  to  those  in  wine.  Even  though  a 
pharmacopoeia  should  arrive  at  the  highest  and 
most  unquestioned  point  of  excellence,  still 
physicians  woukl  suit  themselves  with  formulas 
of  their  own,  adapted  to  particular  cases.  We 
apprehend  that  most  practitioners  pass  their 
lives  in  ignorance  of  half  the  contents  of  phar- 
maceutical works.  For  ourselves,  not  being 
particularly  given  to  hyper-practice,  we  should 
feel  a  strong  sentiment  of  pity  for  the  patients 
of  that  physician  whose  yearly  rounds  involved 
the  application  of  the  whole  pharmacopoeia. 

To  conclude, —  having  indulged  somewhat 
freely  in  our  remarks  on  the  national  work 
produced  by  the  convention  at  Washington, 
we  proceed  to  make  the  amende  honorable,  by 
declaring  our  conviction,  that  it  is  on  the  whole 


OF    THE    UNITED    STATES.  265 

superior  to  any  of  the  European  pharmacopoeias 
with  which  we  are  acquainted ;  that  it  is  better 
suited  to  the  wants  of  the  American  commu- 
nity than  any  work  of  the  kind  which  has  been 
published  among  us ;  that  it  has  emanated  from 
a  larger  delegation,  and  has  undergone  a  more 
rigorous  supervision,  than  any  similar  produc- 
tion of  the  day;  and  that,  therefore,  it  ought 
to  become  the  standard  of  the  United  States. 
In  conformity  with  the  views  expressed  in  the 
first  part  of  this  article,  we  also  hope,  that,  to 
relieve  the  profession  from  the  annoyance  of 
incessant  fluctuations,  the  contents  of  this  book 
will  be  respected  by  all  future  conventions  as 
something  solid  and  permanent ;  ancl  that  if, 
as  the  edifice  grows  old,  it  shall  be  found  to 
need  repairs,  enlargement,  or  modern  decora- 
tions, still  that  its  foundations  may  not  be 
wantonly  assailed,  and  that  its  walls  may  stand 
as  a  landmark  and  a  barrier  against  the  confu- 
sion of  fluctuating  language. 


ON  THE  MUCUNA  PRURIENS 


WITH   REMARKS   ON 


THE  IRRITABILITY  OF  DIFFERENT  TEXTURES. 


THE  Dolichos  pruriens  of  Linnaeus,  now  call- 
ed Mucuna  pruriens,  and,  in  English,  Cowhage, 
is  a  climbing  plant  of  the  West  Indies,  the  pods 
or  seed-vessels  of  which  are  covered  with  stiff, 
sharp  bristles,  or  spiculse.  I  have  examined 
these  bristles  in  a  microscope,  and  find  them  to 
be  extremely  acute,  hollow,  and  apparently  cov- 
ered on  the  outside  with  little  warts  or  vesicles. 

It  is  well  known  that  when  these  bristles  are 
rubbed  on  the  skin,  they  excite  an  intense  and 
violent  itching,  which  lasts  for  a  considerable 
time.  They  have  been  sometimes  indiscreetly 
used  as  a  counter-irritant,  applied  to  the  skin, 
by  spreading  from  four  to  six  grains  on  lint,  and 


ON    THE    MUCUNA    PRURIENS.  267 

confining  it  with  adhesive  plaster.  The  result, 
within  my  observation,  has  been  an  exceedingly 
uncomfortable  itching  and  burning  of  the  part, 
which  on  the  second  day  became  universally 
red  and  inflamed.  A  copious  eruption  of  papu- 
lae followed,  which  increased  in  size  for  a  week, 
and  at  length  terminated  in  pustules,  which  re- 
quired a  second  week  to  pass  into  scabs.  In 
one  patient  two  or  three  large  prominences  like 
boils,  continued  for  ten  days  after  the  rest  of  the 
part  was  well. 

The  irritation  produced  by  cowhage  appears 
to  me  greatly  to  exceed  that  which  attends  the 
application  of  flies  or  of  tartar  emetic.  One 
patient,  a  woman,  assured  me  she  got  no  rest 
for  two  nights.  On  examining  the  skin,  it  was 
found  in  a  state  of  great  inflammation,  exquisite 
tenderness,  and  stuck  full  of  the  spiculee.  After 
attempting  in  vain  to  relieve  the  trouble  by  a 
poultice,  recourse  was  had  to  a  mixture  of  Plas- 
ter of  Paris  and  water,  which  was  poured  and 
suffered  to  harden  upon  the  skin.  When  with- 
drawn from  the  skin,  it  extracted  and  brought 
with  it  the  spiculas,  to  the  great  relief  of  the 
patient.  The  same  experiment,  however,  prov- 


268  ON    THE    MUCUNA    PRURIENS. 

ed  inapplicable  to  a  man  whose  breast  was 
covered  with  hairs,  and  did  not  admit  of  the 
process. 

Cowhage  was  introduced  into  practice,  I  be- 
lieve, by  Dr.  Chamberlain,  who  has  published  a 
small  work  upon  it,  strongly  recommending  it 
as  a  remedy  for  worms.  Reasoning  probably 
a  priori,  he  supposed  that  a  substance  which 
occasions  so  much  irritation  to  the  human  skin, 
would  act  in  a  similar  manner  upon  the  bodies 
of  worms  in  the  alimentary  canal.  Finding 
that  when  mixed  with  honey  or  molasses,  it 
could  be  swallowed  with  impunity,  this  author, 
and  subsequent  writers  of  Dispensatories,  have 
recommended  its  use  as  a  remedy  for  worms,  in 
the  dose  of  from  five  to  ten  grains.  When 
strong  cathartics  have  followed  its  employment, 
worms  in  some  cases  have  been  brought  to  light, 
but  I  apprehend  not  more  frequently  than  in 
cases  where  no  cowhage  has  been  given.  Many 
years  ago,  having  occasion  to  doubt  the  anthel- 
mintic  properties  of  this  medicine,  after  it  should 
have  undergone  the  process  of  digestion  in  the 
stomach,  I  performed  with  it  a  number  of  expe- 
riments. A  parcel  of  the  spiculae  of  full  strength 


ON    THE    MUCUNA    PRURIENS.  269 

were  soaked  in  blood-warm  water  for  about  ten 
minutes.  On  withdrawing  them,  they  were 
found  softened,  apparently  deprived  of  their 
venom,  and  wholly  incapable  of  irritating  the 
skin  when  rubbed  upon  it.  Another  portion 
was  tied  up  in  a  muslin  bag,  and  forced  into  the 
stomach  of  a  cat.  At  the  end  of  ten  minutes  an 
emetic  was  administered,  which  brought  up  the 
bag  with  the  spiculaB  so  far  digested  that  they 
could  not  be  made  to  give  the  slightest  irritation 
to  the  skin.  I  am  therefore  obliged  to  conclude 
that  the  vermifuge  action  attributed  to  cowhage 
was  in  reality  due  to  the  cathartics  which  fol- 
lowed its  use. 

Within  a  few  weeks  past,*  I  have  noticed 
another  curious  property  of  the  dolichos,  that  it 
stimulates  the  skin,  but  does  not  stimulate  the 
mucous  membrane.  Applied  to  the  hand,  for 
example,  it  immediately  causes  violent  itching; 
but  if  rubbed  on  the  inside  of  the  lip,  or  tongue, 
it  excites  no  sensation  beyond  the  ordinary  me- 
chanical stimulus.  In  like  manner  the  effect  on 
the  outside  and  inside  of  the  cheek  are  wholly 

*  January,  1844. 


270        ON  THE  MUCUNA  PRURIENS. 

different.  It  is  this  fact,  probably,  and  not  the 
sheathing  quality  of  the  mucilage  or  syrup  in 
which  it  is  taken,  that  enables  patients  at  all 
times  to  swallow  it  with  impunity,  as  a  medi- 
cine. 

It  is  a  field  of  interesting  inquiry  to  ascertain 
how  far  particular  morbid  poisons  and  stimu- 
lants confine  their  action  to  particular  textures. 
As  far  as  my  observation  extends,  the  cutaneous 
poisons  which  produce  eruptions  on  the  skin 
independent  of  any  acrimony,  or  general  stim- 
ulating quality,  such  as  the  Rhus  vernix,  &c., 
for  the  most  part  confine  their  action  to  the  true 
skin  or  dermoid  texture,  and  do  not  inflame  the 
mucous  membrane,  so  that  they  have  often  been 
eaten  with  impunity.  Were  it  otherwise,  effects 
highly  dangerous  to  life  would  occur  from  the 
inflammation  of  the  trachea  and  other  mucous 
passages,  if  an  action  should  take  place  in  them 
at  all  correspondent  in  violence  to  that  which  is 
seen  upon  the  skin.  But  there  is  another  class 
of  poisons  which  affects  the  mucous  membrane, 
without  incommoding  the  skin,  at  least  by  su- 
perficial contact.  Such  is  the  effluvium  of 
roses  and  that  of  new  hay,  which  always  affect 


ON    THE    MUCUNA    PRURIENS.  271 

certain  persons  with  catarrhal  symptoms.  Such 
is  also  the  poison  of  syphilis  and  that  of  gonor- 
rhoea, which  are  believed  not  to  act  through  the 
cuticle,  but  which  develop  their  activity  as  soon 
as  they  are  brought  in  contact  with  a  mucous 
surface. 

There  are  other  poisons,  which  seem  alike  to 
influence  the  dermoid  and  mucous  tissues.  The 
sting  of  a  bee  or  wasp  immediately  inflames  the 
skin,  and  it  is  said  to  have  occasioned  death  by 
suffocation  when  applied  to  the  fauces  or  throat. 
It  is  possible  that  the  morbid  poison  of  scarla- 
tina, and  of  some  other  diseases  which  affect 
simultaneously  the  skin  and  mucous  membrane, 
may  possess  the  same  universality  of  action. 


ON    THE 

POISONOUS  EFFECTS 

or 

THE  AMERICAN  PARTRIDGE,  OR  RUFFED  GROUSE. 

THE  Tetrao  umbellus  of  Linnaeus,  variously 
called  Partridge  in  the  northern  and  eastern 
States,  Pheasant  in  Pennsylvania  and  the  west- 
ern States,  and  "  Ruffed  Grous"  by  Wilson,  Nut- 
tall,  and  Audubon,  appears  to  inhabit  the  conti- 
nent from  Hudson's  Bay  to  the  Gulf  of  Mexico, 
and  from  the  Atlantic  to  the  Mississippi.  It  is 
a  handsome  bird  of  the  Gallinaceous  tribe,  with 
mottled  plumage,  the  tail  18-feathered,  speckled, 
and  barred  with  black,  and  with  a  black  subter- 
minal  band.  The  male  has  a  ruff  of  broad 
black  feathers  on  the  sides  of  the  neck,  the 
female  a  smaller  ruff  of  a  dusky  brown.  Its 


THE    AMERICAN    PARTRIDGE.  273 

favorite  resorts  are  mountainous  regions  covered 
with  evergreen  trees,  and  in  more  cultivated 
countries  it  often  frequents  apple-trees,  which 
are  secluded  or  concealed  by  woods,  having  a 
fondness  for  the  buds  of  this  tree.  It  is  well 
known  to  residents  in  the  interior,  by  the  drum- 
ming noise  which  in  the  pairing  season  it  makes 
with  its  wings,  and  also  by  the  stratagem  with 
which  the  mother  protects  her  young  by  an  illu- 
sive demonstration  of  surrendering  herself  in 
their  place. 

The  partridge  is  quite  common  in  the  eastern 
States,  and  constitutes  one  of  the  most  frequent 
kinds  of  game  in  our  markets.  The  flesh  is 
much  prized  for  the  delicacy  of  its  flavor,  and  is 
in  its  greatest  perfection  in  September  and  Oc- 
tober. It  feeds  in  summer  on  wild  berries,  and 
at  other  seasons  on  the  leaves,  buds,  and  seeds 
of  various  plants. 

It  is  generally  known,  that  although  vast 
numbers  of  these  birds  are  every  year  consumed 
with  impunity,  yet  instances  now  and  then  hap- 
pen of  persons  being  apparently  poisoned  or 
made  sick  with  alarming  symptoms,  soon  after 
swallowing  their  flesh.  The  following  cases  are 
18 


274  ON    THE    POISONOUS    EFFECTS    OF 

selected  from  among  a  larger  number,  which 
have  been  observed  by  myself  or  my  medical 
friends,  and  of  which  a  part  are  in  the  records 
of  the  Society  of  Medical  Improvement. 

CASE  I.  —  A  gentleman  of  this  city  having 
dined  at  Worcester  in  part  upon  partridge,  took 
the  cars  for  Boston  half  an  hour  afterward. 
In  an  hour  after  entering,  he  was  taken  with 
sensations  like  those  of  sea  sickness,  accompa- 
nied with  dizziness  and  great  prostration  of 
strength.  With  difficulty  he  got  his  head  out 
and  vomited  from  the  window  of  the  car.  He 
continued  faint,  cold,  dizzy,  and  unable  to  sit 
up,  with  ringing  in  the  ears  and  imperfect  vision. 
He  was  conveyed  to  his  house  in  a  sinking  and 
nearly  insensible  state.  When  I  first  saw  him, 
he  was  cold  and  moist,  with  a  slow  intermittent 
and  very  feeble  pulse,  difficult  comprehension, 
and  sluggish  utterance.  He  had  vomited  again 
with  some  relief.  His  vision  was  partially  re- 
covered. Stimulants  had  been  given  him,  with 
hot  applications  and  frictions  to  the  surface, 
under  which  he  gradually  recovered. 


THE    AMERICAN    PARTRIDGE.  275 

CASE  II.  —  A  lady  of  delicate  health  took  at 
dinner  a  small  piece  of  the  breast  and  leg  of  a 
partridge.  Two  hours  afterward  she  became 
suddenly  very  faint,  and  her  physician  (Dr.  Put- 
nam) was  called.  She  was  found  by  him  in  a 
sitting  posture  on  the  bed,  supported  by  two 
assistants,  with  the  body  bent  forward.  The 
surface  was  generally  cold,  countenance  pale 
and  sunken,  and  voice  feeble.  There  was 
slight,  frequent  convulsive  action  of  the  muscles. 
The  pupils  were  dilated,  with  loss  of  vision. 
Pulse  irregular,  feeble,  at  times  nearly  imper- 
ceptible. There  was  drowsiness  approaching 
to  insensibility,  nausea  and  vomiting.  Spiritu- 
ous stimulants  were  given  and  ipecacuanha, 
with  warmth,  friction  and  sinapisms  externally. 
Soon  after  free  vomiting  took  place  there  was 
evident  amendment.  The  sensibility  returned, 
questions  were  comprehended,  but  the  answers 
were  slow  and  laborious.  In  the  course  of  two 
or  three  hours  vision  was  restored  with  contrac- 
tion of  the  pupils  and  intolerance  of  light,  with 
a  remaining  sense  of  numbness  and  uneasiness 
in  the  head. 


276  ON    THE    POISONOUS    EFFECTS    OF 

CASE  III.  —  A  man  aged  sixty,  who  had  al- 
ways been  healthy,  but  within  a  few  months 
troubled  with  shortness  of  breath,  which  his 
physician  attributed  to  some  affection  of  the 
heart,  ate  the  white  meat  of  a  partridge,  avoid- 
ing the  dark  meat  and  the  parts  contiguous  to 
it.  About  an  hour  afterwards  he  went  to  church, 
where  he  was  shortly  taken  with  a  sensation  of 
distress  at  the  stomach,  which  he  referred  to 
the  disagreement  of  his  food.  He  endeavored 
to  resist  this  annoyance,  and  kept  his  seat  for 
some  time,  but  at  length  his  sight  totally  left 
him,  he  became  faint,  and  fell.  He  was  carried 
out  of  church,  and  laid  on  his  back  in  the  open 
air.  At  this  time  there  was  no  pulse,  and  the 
respiration  was  hardly  perceptible.  These 
symptoms  were  at  first  attributed  by  those 
around  to  the  suspected  disease  of  the  heart, 
but  in  the  course  of  ten  minutes  he  began  to 
revive.  The  first  word  he  uttered  was  '  poison- 
ed,' and  the  second,  '  the  partridge.'  He  soon 
began  to  revive,  sat  up,  got  upon  his  feet  with 
assistance,  but  had  lost  all  power  over  his  legs, 
and  was  unable  to  stand.  He  was  now  put 
into  a  carriage,  some  pressure  was  made  upon 


THE    AMERICAN    PARTRIDGE.  277 

the  stomach,  and  he  began  to  vomit.  Ipecac 
and  warm  water  were  given  him  until  the 
stomach  was  fully  evacuated.  He  remained 
somewhat  delirious  for  a  few  hours,  but  on  the 
following  day  was  restored  to  his  customary 
health. 

CASE  IV. —  A  gentleman,  twenty-six  years  of 
age,  dined  at  5  P.  M.  on  soup,  boiled  tongue  and 
potatoes,  and  ate  the  leg  and  part  of  the  breast 
of  a  partridge.  .  He  afterwards  went  to  a  club- 
room,  and  remained  till  8.  On  going  out  at 
this  time  he  became  chilly,  and  felt  a  sharp 
pain  through  the  temples.  He  repaired  to  a 
shop  for  some  soda-water,  and  while  standing 
there  was  affected  with  vertigo  and  a  '  trance- 
like'  feeling.  This  was  followed  by  ringing  in 
the  ears,  and  a  remarkable  sense  of  coldness, 
mostly  in  the  back  of  the  neck  and  shoulders. 
He  was  unable  to  get  warm  at  the  fire,  and  the 
sensation  given  to  bystanders  by  his  head  was 
compared  to  that  of  the  contact  of  a  stone  jar. 
He  had  taken  hot  spirit  and  water,  and  was 
sitting  up  when  seen  by  Dr.  Holmes  at  9  o'clock. 
At  this  time  the  voice  and  expression  were 


278  ON    THE    POISONOUS    EFFECTS    OF 

natural,  mind  a  little  excited,  vision  dim  at 
times  and  once  or  twice  quite  lost,  pupils  widely 
dilated  and  equal,  contracting  but  slightly  on 
the  approach  of  a  light,  hands  rather  cold,  pulse 
76,  regular,  small  but  not  thready,  no  nausea  nor 
vomiting.  Took  wine  of  ipecac,  and  threw  off 
freely  portions  of  food.  In  the  course  of  half 
an  hour  was  thoroughly  relieved,  but  was  lan- 
guid and  costive  next  day. 

Two  or  three  other  persons,  as  it  appeared, 
had  partaken  of  the  same  partridge  without 
obvious  inconvenience. 

CASE  V. —  A  gentleman,  aged  seventy-four, 
of  full  habit  and  subject  to  gout,  ate  at  breakfast 
the  black  meat  of  one  partridge.  In  an  hour  or 
two  he  went  to  church,  where  he  soon  became 
sick,  faint  and  dizzy.  On  being  carried  home 
he  was  found  in  a  state  approaching  that  of 
collapse,  pale,  livid,  cold,  nearly  pulseless,  and 
without  vision.  His  appearance  was  that  of  a 
dying  man  with  glazed  eyes  and  gasping  for 
breath.  Had  repeated  nausea,  but  vomited 
fluids  only.  Took  stimulants,  principally  hot 
gin  and  water,  and  gradually  recovered,  after 


THE   AMERICAN    PARTRIDGE.  279 

passing  a  restless  night  with  much  thirst.  It 
was  remarked  that  others-  of  the  family  ate  the 
white  meat  of  the  same  bird  without  any  disa- 
greeable consequences. 

CASE  VI. —  A  female,.  whx>  had  eaten  at  12 
o'clock  of  the  white  and  black  meat  of  a  par- 
tridge, in  half  an  hour  was  taken-  with  pain  in 
the  chest  and  throat,  nausea,  weaker-ess  and  loss 
of  sight.  "Was  seen  by  her  physician  at  4  P.  M. 
Her  pulse  was  54,  and  hardly  perceptible.  After 
taking  brandy  and  water  and  half  a  drachm  of 
ipecac,  her  pulse  improved  in  strength,  but  was 
still  54  only.  Her  mind  remained  clear,  and 
the  most  remarkable  symptoms  were  the  blind- 
ness and  slow  and  feeble  pulse. 

CASE  VII. —  An  elderly  gentleman,  of  full 
habit,  breakfasted  in  part  on  a  partridge.  In 
two  hours  he  was  seized  with  dizziness,  partial 
loss  of  consciousness,  and  violent  pain  extend- 
ing through  the  abdomen  to  the  back.  When 
visited  by  Dr.  H.  J.  Bigelow,  he  was  found  on 
his  hands  and  knees,  cold,  faint,  partly  insensi- 
ble and  nearly  pulseless.  The  pain  having  sub- 


280  ON    THE    POISONOUS    EFFECTS    OF 

sided,  returned  at  intervals,  causing  him  to  call 
often  to  have  his  back  rubbed.  After  an  emetic 
he  was  much  relieved,  and  rallied  slowly  in 
the  course  of  the  afternoon. 

CASE  VIII. —  For  this  and  the  two  following, 
I  am  indebted  to  Dr.  Morrill  Wyman. 

A  very  athletic  and  active  man,  aged  fifty,  at 
times  making  very  great  and  long-continued 
exertion  and  eating  freely,  February  14,  1849, 
took  supper  at  7  P.  M. ;  ate  two  roasted  par- 
tridges, with  ale  and  other  liquors.  At  8  o'clock 
felt  somewhat  heavy,  and  thinking  he  had  eaten 
too  much  supper,  proposed  to  go  to  the  bowling 
alley  for  exercise.  In  a  few  minutes  perceived 
that  the  lights  in  the  room  had  a  blue  tinge,  the 
fire  also  ;  asked  if  any  new  kind  of  burning 
fluid  had  been  used,  and  immediately  fell,  with 
loss  of  consciousness.  Just  previously  to  the 
loss  of  consciousness,  had  pain  in  the  back  of 
the  neck,  extending  down  along  the  spine  and 
into  the  arm.  In  ten  or  fifteen  minutes  partially 
recovered, — then  again  unconscious  ;  muscles 
of  limbs  completely  relaxed;  face  very  pale; 
respiration  four  to  six  times  per  minute ;  pulse 


THE    AMERICAN    PARTRIDGE.  281 

18  to  22 ;  hands  and  feet  cold  and  moist ; 
groaned  frequently  ;  vomited  freely  and  spon- 
taneously, and  afterwards  under  the  influence 
of  mustard  flour  mixed  with  warm  water.  Warm 
blankets  and  bottles  of  hot  water  were  applied 
to  the  epigastrium  and  limbs,  and  in  the  course 
of  two  hours  he  had  recovered  his  consciousness 
and  drank  warm  tea.  Slept  well  during  the 
night.  In  the  morning  was  quite  well. 

CASE  IX.  —  Same  individual.  February  23, 
1850,  went  into  the  country  in  the  morning  and 
rode  till  3  o'clock,  P.  M. ;  then  sat  down  in  the 
open  air  and  ate  a  part  of  a  partridge,  but  it 
was  so  bitter  that  the  remainder  was  thrown 
away ;  drank  a  wine-glass  of  brandy.  Took 
railroad  train,  and  on  leaving  it  in  thirty-five 
minutes  walked  from  fifteen  to  twenty  min- 
utes, when  (about  one  hour  after  eating  the 
partridge,)  had  pain  in  the  back  of  the  neck  and 
limbs,  Passed  a  house,  and  observed  that  the 
lights  appeared  blue,  and  immediately  suspect- 
ed the  partridge  of  being  the  cause  of  his  trou- 
bles. Soon  after,  found  himself  at  the  bottom 
of  a  steep  declivity,  having  lost  his  conscious- 


282  ON    THE    POISONOUS    EFFECTS    OF 

ness  and  rolled  down  a  bank.  Got  up,  and 
walked  to  a  house ;  again  noticed  the  blue 
lights.  In  attempting  to  take  a  glass  of  cold 
water  again  lost  his  consciousness  and  fell ;  was 
carried  home,  and  after  taking  mustard  flour, 
vomited  and  was  soon  relieved.  Before  vomit- 
ing, respiration  very  slow  and  not  more  than  half 
the  usual  number  of  inspirations.  Pulse  42  per 
minute  ;  hands  and  feet  cold  and  the  face  pale. 
During  the  periods  of  loss  of  consciousness, 
which  did  not  continue  more  than  five  minutes 
at  a  time,  the  limbs  were  quite  powerless.  The 
recovery  was  sudden,  and  the  action  energetic ; 
speech  impeded,  apparently  from  want  of  mus- 
cular  power.  Time  elapsed  between  first  symp- 
toms and  relief  by  vomiting,  from  an  hour  and 
a  half  to  two  hours. 

CASE  X.  —  Mrs.  W.,  aged  forty -five,  ate  for 
dinner,  two  days  before  the  date  of  the  last  case, 
a  part  of  a  roasted  partridge,  bought  at  the 
same  time  with  that  used  by  her  husband. 
This,  also,  was  extremely  bitter,  and  only  a 
small  quantity  eaten.  After  dinner  walked  a 
mile  to  a  conservatory  ;  when  near  the  conserv- 


THE    AMERICAN    PARTRIDGE. 


283 


atory  felt  weak ;  pain  in  both  back  of  neck  and 
limbs.  Felt  faint  in  the  conservatory,  and 
obliged  to  return  to  the  open  air ;  was  nausea- 
ted, but  did  not  vomit.  Immediately  walked 
towards  home ;  found  her  limbs  unsteady,  obliged 
to  run  and  then  stop  and  support  herself  by  the 
fence  ;  was  compelled  to  lie  down,  but  did  not 
lose  consciousness ;  was  carried  home.  The  pain 
in  the  back  of  the  neck  and  limbs  continued  till 
9  o'clock,  when  she  went  to  bed.  Had  occasion- 
ally some  difficulty  of  breathing,  a  catching  of 
the  breath.  In  the  morning  was  quite  well. 

Neither  of  these  individuals  have  eaten  par- 
tridges since. 

The  principal  and  most  characteristic  symp- 
toms were  loss  of  consciousness ;  relaxation  of 
the  muscles,  and  in  one  instance  of  the  sphinc- 
ters ;  paleness ;  Cold  feet  and  hands ;  slow  and 
infrequent  respiration,  and  slow  and  infrequent 
but  regular  pulse.  The  act  of  vomiting  was 
followed  by  almost  immediate  relief. 

To  these  cases  may  be  added  a  number  more, 
the  outlines  of  which  have  been  communicated 
by  different  medical  friends. 


284  ON    THE    POISONOUS    EFFECTS    OF 

From  a  general  analysis  of  the  symptoms 
produced,  it  appears  that  under  certain  circum- 
stances the  flesh  of  the  partridge  acts  as  a  direct 
sedative  poison,  impairing  the  functions  of  the 
brain,  and,  in  connection,  those  of  the  digestive 
and  circulating  systems.  The  cerebral  symp- 
toms, in  a  majority  of  cases,  have  been  vertigo, 
loss  of  sight,  tinitus  aurium,  and  in  bad  cases 
general  loss  of  the  power  of  sensation  and  vol- 
untary motion.  Respiration  has  been  slow, 
sometimes  to  a  great  degree.  In  the  circulating 
system  there  has  been  syncope,  feeble  and  some- 
times irregular  action  of  the  heart ;  weak,  slow, 
and  sometimes  imperceptible  pulse ;  cold  sur- 
face, and  pale  or  livid  complexion.  In  the 
digestive  system  there  is  oppression,  nausea 
with  tendency  to  vomit,  and  in  many  cases  pain 
in  the  abdomen  extending  through  to  the  back. 
In  more  rare  cases  pain  has  been  felt  in  the 
head  and  limbs. 

The  foregoing  morbid  symptoms  have  mostly 
appeared  within  two  or  three  hours  after  taking 
the  food.  But  instances  have  occurred  in  which 
persons  have  been  taken  before  leaving  the  table. 

The  poison  of  the  partridge  has  never,  to  my 


THE    AMERICAN    PARTRIDGE.  285 

knowledge,  proved  fatal.  The  remedies  usually 
and  properly  resorted  to,  are  a  prompt  emetic, 
accompanied  or  followed  by  stimulants,  if  the 
prostration  is  urgent.  Free  spontaneous  vomit- 
ing not  unfrequently  removes  the  difficulty  be- 
fore the  physician  arrives.  Acrid  stimulants, 
such  as  a  teaspoonful  of  mustard,  may  serve  the 
double  purpose  of  a  quick  emetic  and  an  in- 
citant  to  the  depressed  vital  powers.  Spirits, 
and  other  diffusible  stimulants,  are  indicated  by 
the  sinking  condition  of  the  patient,  but  the 
anxiety  of  friends  often  leads  to  their  excessive 
administration,  for  which  the  patient  pays  by  a 
prolonged  continuance  of  his  narcotism.  Fric- 
tion and  external  warmth  are  indicated  and 
generally  'desired  by  the  patient. 

The  flesh  of  the  partridge  is  justly  esteemed 
as  a  great  delicacy,  and  is  abundantly  sold  in 
the  markets  of  this  and  many  other  cities. 
Audubon  says  of  it :  { In  my  humble  opinion  it 
far  surpasses  as  an  article  of  food  any  land  bird 
we  have  in  the  United  States,  except  the  wild 
turkey.'  It  is  in  its  best  condition  in  the  fall  of 
the  year,  and  continues  to  be  common  through- 


286  ON    THE    POISONOUS    EFFECTS    OF 

out  the  winter.  We  have  hardly  any  species  of 
game  which  is  sought  for  with  more  avidity,  or 
consumed,  in  proportion  to  its  size,  in  greater 
numbers.  As  a  general  rule,  it  is,  and  may  be 
taken  with  perfect  impunity. 

The  fact  that  the  meat  of  the  partridge  occa- 
sionally proves  poisonous,  has  given  rise  to 
much  speculation  in  regard  to  the  cause.  The 
point  most  generally  admitted  respecting  it,  is, 
that  its  bad  effects  chiefly,  if  not  always,  take 
place  in  winter,  when  the  ground  is  covered 
with  snow.  This  circumstance  has  given  rise 
to  a  popular  belief  that  the  noxious  quality  in 
the  meat  of  the  bird  is  attributable  to  some  poi- 
sonous food  on  which,  in  winter,  it  is  driven  to 
subsist.  And  a  prevalent  suspicion  has  been 
fixed  upon  the  mountain  laurel  (Kalmia  latifolia), 
on  the  buds  and  leaves  of  which  the  partridge 
has  been  supposed  to  feed  in  cold  weather. 
But  this  suspicion  appears  to  be  not  well  found- 
ed, since  I  have  observed  in  experiments  made 
purposely,  that  the  leaves  of  the  kalmia  are  not 
particularly  poisonous,  when  taken  into  the 
human  stomach  in  any  quantity  which  the  bird 
would  be  likely  to  devour ;  and  the  crops,  when 


THE    AMERICAN    PARTRIDGE.  287 

examined  in  winter,  are  found  to  contain  leaves 
and  fragments  of  most  of  the  wild  evergreen 
plants  which  are  in  verdure  at  that  time.  I 
have  found  among  other  things  portions  of 
leaves  of  Pyrola,  Gaultheria,  Smilax,  Coptis, 
Mitchella — also  buds  of  Azalea,  alder  and  apple 
tree,  which  latter  appears  to  be  a  favorite  food 
with  the  partridge. 

It  is,  furthermore,  not  very  probable  that  the 
common  process  of  putrid  decomposition  is  con- 
cerned in  producing  the  noxious  effects  in  ques- 
tion, for  this  circumstance  would  be  generally 
detected  by  the  taste,  and  the  incipient  putres- 
cency  so  often  recognized  in  game  is  usually 
corrected  by  the  antiseptic  effect  of  the  gastric 
juice. 

More  probable  solutions  of  the  difficulty  are, 
1.  That  the  bird  is  affected  with  some  disease 
at  the  time  of  its  death.  2.  That  some  slow 
chemical  change,  not  putrefactive,  may  take 
place  when  the  flesh  is  long  kept  in  cold  weath- 
er, as  observed  by  my  friend  Dr.  Cabot.  3.  That 
the  idiosyncrasy  of  individuals  renders  some 
persons  intolerant  of  this  species  of  food.  This 
latter  supposition  is  sustained  by  the  facts,  that 


288  THE    AMERICAN    PARTRIDGE. 

the  same  person  has  sometimes  been  affected 
twice,  —  that  a  majority  of  persons,  partaking  of 
the  same  partridge,  escape  unharmed,  when 
others  are  poisoned, — and  that  individuals  are 
found  who  cannot  eat  lobster,  mackerel  and 
certain  other  kinds  of  food  without  suffering 
symptoms  approaching  in  character  to  those 
already  described. 


ON  COFFEE  AND  TEA; 

AND  THEIR  MEDICINAL  EFFECTS. 

THE  articles  Coffee  and  Tea  have  been  so 
long  and  so  generally  introduced  as  luxuries  of 
the  table,  that  they  are  now  viewed  by  the 
world  as  materials  of  diet  and  nutrition,  and 
not  in  their  proper  light,  as  substances  incapa- 
ble of  nourishing  the  body  in  any  considerable 
degree,  and  depending  for  their  value  on  an 
effect  which  is  simply  medicinal.  If  any  one 
doubts  whether  they  should  be  referred  to  the 
class  of  aliments,  or  to  that  of  medicines,  let 
him  try  the  experiment  of  supporting  life  upon 
coffee  or  tea  alone,  and  he  would  probably  find 
that  his  term  would  not  be  much  prolonged 
by  such  an  expedient.  Yet,  when  taken  in 
combination  with  nutritious  food,  both  these 
articles  exert  a  salutary  and  useful  influence 
upon  digestion  and  health.  The  experience  of 
10 


290  ON    COFFEE    AND    TEA. 

all  civilized  nations  has  shown  them  to  be 
innocent,  when  used  at  proper  times  and  in 
moderate  quantities,  while,  like  all  other  medi- 
cinal substances,  they  are  capable  of  abuse,  if 
taken  under  improper  circumstances  or  to  an 
excessive  degree. 

As  these  two  substances  have  a  close  affinity 
to  each  other,  possessing  properties  not  known 
to  exist  in  any  other  plant,  they  are  properly 
associated  with  each  other  as  a  class  under  the 
name  of  anthypnotics.  Should  any  plant  be  here- 
after found  to  possess  qualities  similar  to  those 
of  coffee  and  tea,  it  would  doubtless  acquire  an 
immediate  value,  and  perhaps  be  in  the  same 
request  as  these  imported  articles.  The  subject 
is  an  interesting  one  for  future  inquiry,  and  al- 
ready an  identity  in  the  active  alkaloid  principle 
has  been  asserted  for  some  species  of  Ilex  and 
Paullinia,  consumed  by  the  inhabitants  of  South 
America. 

The  prevailing  fondness  for  coffee  and  tea  is 
probably  an  acquired  taste,  like  that  for  tobacco 
and  alcohol.  The  flavor  of  both  these  articles 
in  their  crude  state  is  disagreeable  to  most 
persons  not  already  initiated  in  their  use.  But 


ON    COFFEE    AND    TEA.  291 

the  discovery  in  modern  times  of  their  second- 
ary effects,  and  the  agreeable  influence  which 
they  exert  on  the  brain  and  nervous  system, 
has  created  for  them  a  general  demand  and 
consumption  throughout  the  world. 


Coffee  is  the  product  of  the  Coffcea  Arabica, 
a  small  tree  which  grows  native  in  Arabia  and 
several  warm  countries  of  the  old  continent, 
and  is  now  cultivated  extensively  in  the  West 
Indies  and  tropical  parts  of  the  continent  of 
America.  The  fruit  of  this  tree  is  a  roundish 
oblong  berry,  containing  two  seeds,  the  form 
and  appearance  of  which  are  sufficiently  familiar, 
constituting  the  common  coffee  which  is  brought 
to  this  country. 

The  use  of  coffee  was  unknown  to  the  Greeks 
and  Romans,  and  does  not  appear  to  have  been 
known  in  the  Asiatic  countries  as  late  as  the 
time  of  the  Crusades  in  the  thirteenth  century, 
although  its  first  introduction  into  Europe  was 
from  Arabia.  It  seems  to  have  been  earliest  in 
use  in  Ethiopia,  where  it  has  been  drunk  by 
the  natives  for  a  great  length  of  time.  Mr. 


292  ON    COFFEE    AND    TEA. 

Bruce,  in  his  Travels  in  Abyssinia  states,  that 
the  Gallse,  a  wandering  nation  of  Africa,  in 
their  incursions  on  Abyssinia,  being  obliged  to 
traverse  immense  deserts,  and  wishing  to  be 
encumbered  with  as  little  baggage  as  possible, 
take  with  them  a  mixture  of  coffee  and  butter 
rolled  up  into  balls,  and  carried  in  a  leathern 
bag.  One  of  these,  about  the  size  of  a  billiard 
ball,  keeps  them,  they  say,  in  strength  and 
spirits  during  a  day's  fatigue.  Coffee  was  in- 
troduced into  Mecca,  Medina  and  Cairo  about 
the  middle  of  the  fifteenth  century,  and  two 
coffee-houses  were  opened  at  Constantinople 
in  1554.  Both  at  Cairo  and  in  Turkey  it  had 
to  encounter  political  and  religious  opposition ; 
the  dervises  affirmed  that  roasted  coffee  was 
nothing  but  a  coal,  and  that  the  eating  of  coals 
was  forbidden  by  the  laws  of  their  prophet. 
So  that  the  coffee-houses  were  obliged  to  be 
shut  up  until  '  a  more  sensible  mufti '  succeed- 
ed in  convincing  the  people  that  roasted  coffee 
was  not  a  coal,  upon  which  they  were  again 
opened.  In  later  years  the  use  of  coffee  be- 
came extremely  prevalent  throughout  the  east. 
Houses  for  selling  it  were  established  in  all 


ON    COFFEE    AND   TEA.  293 

parts  of  the  Turkish  empire  ;  it  was  introduced 
into  private  families,  and  the  refusal  of  a 
husband  to  supply  his  wife  with  coffee  was 
reckoned  among  the  legal  causes  of  a  di- 
vorce. 

In  Europe  coffee  was  introduced  into  France 
and  England  about  a  century  and  a  half  ago. 
So  rapid  was  the  progress  of  a  taste  for  it  after 
it  became  known,  that  in  eight  years  from  its 
introduction,  it  had  become  in  England  a  subject 
of  public  revenue. 

Coffee  has  seldom  been  used  in  its  raw 
state,  except  sometimes  as  a  fanciful  addition 
to  certain  liqueurs  and  ices.  A  decoction  of  raw 
coffee  is  disagreeable  to  the  taste,  but  appears 
to  possess  properties  analogous  to  those  which 
it  exhibits  after  being  roasted.  The  roasting 
of  coffee  improves  its  flavor,  and  occasions 
considerable  changes  in  its  chemical  constitu- 
tion, without  impairing  its  stimulant  or  medi- 
cinal activity.  A  peculiar  alkaloid,  called  caf- 
feine, is  detected  in  both  raw  and  roasted  coffee. 
It  is  considered  by  chemists  to  be  identical 
with  theine,  found  in  tea  and  in  a  few  other 
vegetables.  An  aromatic  oil,  which  has  been 


294 


ON    COFFEE    AND    TEA. 


called  caffeone^  is  produced  during  the  process 
of  roasting. 

During  the  extensive  trial  which  has  been 
made  all  over  the  world,  as  to  the  effect  of 
coffee  upon  the  health,  no  small  diversity  of 
opinion  has  existed  in  regard  to  its  specific 
powers.  Of  the  properties  ascribed  to  it,  two 
seem  better  established  than  any  others.  These 
are  its  property  of  assisting  digestion,  and  that 
of  obviating  drowsiness.  Coffee,  when  taken 
into  the  stomach,  usually  creates  a  pleasing 
sense  of  vigor  in  that  organ,  it  moderates  ali- 
mentary fermentation,  takes  off  the  feeling  of 
distension  and  heaviness  occasioned  by  over- 
eating, counteracts  in  some  degree  the  fumes 
of  wine,  and  produces  a  lightness  and  hilar- 
ity of  mind,  more  moderate  but  more  per- 
manent than  that  occasioned  by  vinous  or 
spirituous  liquors.  The  custom  derived  from 
the  French  of  drinking  coffee  after  dinner,  is 
beneficial,  and  powerfully  promotes  the  process 
of  digestion.  It  is  known  to  epicures  of  most 
countries,  that  a  cup  of  strong  coffee,  at  the 
end  of  some  hours  spent  at  the  table,  enables 
them  to  continue  their  functions,  both  of  body 


ON    COFFEE    AND    TEA.  295 

and  mind,  to  a  greater  extent  than  would  have 
been  done  under  any  other  assistance. 

It  is  well  known  that  coffee  is  strongly  pro- 
motive  of  watchfulness,  and  enables  us  to  resist 
for  a  long  time  the  approaches  of  sleep.  Stu- 
dents, whose  lucubrations  occupy  a  consider- 
able portion  of  the  night,  find  a  great  increase 
of  the  vigilance  and  vigor  of  their  faculties, 
derived  from  the  use  of  both  coffee  and  tea. 
In  fact,  the  long  habit  of  drinking  these  articles 
renders  us  so  dependent  on  them,  for  the  power 
of  keeping  the  mind  awake  and  active,  that  a 
change  from  them  to  any  other  kind  of  diet 
creates  in  most  persons,  at  least  for  a  time,  a 
drowsiness  and  dulness  of  intellect.  Hence  it 
is  common  to  hear  milk  and  chocolate  accused 
of  creating  sleepiness,  an  effect  which  arises,  not 
from  any  real  soporific  influence  in  those  arti- 
cles, but  from  the  change  of  diet,  and  the  want 
of  the  customary  stimulus  of  coffee  and  tea. 
The  Turks  and  Arabians  consume  large  quan- 
tities of  coffee,  because  it  acts  as  an  antidote 
to  the  stupefying  effect  of  opium,  to  the  'abuse 
of  which  those  nations  are  generally  addicted. 
It  has  already  been  mentioned,  and  is  a  fact 


296  ON    COFFEE    AND    TEA* 

which  every  practitioner  should  remember,  that 
perhaps  no  antidotal  substance  exerts  so  pow- 
erful an  agency  in  counteracting  the  effect  not 
only  of  opium,  but  of  alcohol  and  the  whole 
tribe  of  narcotics  as  a  -seasonable  draught  of 
strong  coffee. 

Many  complaints  have  been  ascribed  to  the 
frequent  and  excessive  use  of  coffee,  such 
as  tremors,  headache,  vertigo,  and  some  more 
serious  disorders.  These  complaints  are  most 
apt  to  appear  when  coffee  has  been  taken 
alone,  without  a  sufficient  quantity  of  nourish- 
ment accompanying  it.  It  is  common  for 
physicians,  in  the  course  of  practice,  to  hear 
complaints  of  a  sinking  at  the  stomach,  uni- 
versal trembling  of  the  limbs,  and  a  loss  of 
muscular  power,  coming  on  at  eleven  or  twelve 
in  the  morning,  and  incapacitating  the  patient 
for  business.  These  complaints  I  have,  in  more 
than  half  the  instances  which  have  come  under 
my  notice,  been  able  to  trace  to  a  cup  or  two 
of  strong  coffee,  or  perhaps  tea,  taken  for  break- 
fast without  a  particle  of  nourishment,  or  at 
least  without  a  sufficient  quantity  to  support 
the  system,  during  and  after  the  stimulant  ope- 


ON    COFFEE    AXD    TEA.  297 

ration  of  these  active  liquids.  I  have  generally 
found  these  complaints  to  be  most  effectually 
relieved  by  the  simple  remedy  of  eating,  and 
cured  either  by  increasing  the  quantity  and 
quality  of  nourishment  taken  in  the  morning,  or 
by  exchanging  the  coffee  for  cocoa,  chocolate  or 
milk. 

TEA. 

The  tea  tree,  called  by  Linnaeus  THEA,  is  a 
native  of  Japan,  China,  Tonquin,  and  Assam. 
Linneeus  believed  that  there  were  two  distinct 
species  of  this  genus,  producing  the  green  tea 
and  the  black,  to  which  he  has  given  the  names 
of  Thea  viridis  and  Thea  bohea,  and  distin- 
guishes them  by  the  number  of  petals  in  their 
flowers,  the  one  having  six  petals,  the  other 
nine.  But  subsequent  observers  have  found  the 
number  of  these  organs  to  be  uncertain,  vary- 
ing from  three  to  nine  ;  and  travellers  in  China 
and  Japan,  as  well  as  various  distinguished 
botanists,  have  arrived  at  the  opinion,  that  the 
different  kinds  of  tea  brought  from  those  coun- 
tries are  the  product  of  a  single  species,  subject 
only  to  varieties  from  the  influence  of  soil,  cli- 


298  ON    COFFEE    AND    TEA. 

mate,  time  of  gathering,  and  mode  of  prepara- 
tion. 

The  tea  plant  is  a  small  evergreen  tree  or 
shrub,  of  the  height  of  six  or  eight  feet.  It 
grows  in  the  valleys,  and  on  the  sloping  sides 
of  mountains,  with  a  southern  exposure.  In 
Japan  it  is  planted  around  the  borders  of  fields 
without  regard  to  the  kind  of  soil,  while  in 
China,  where  it  is  an  important  article  of  com- 
merce, whole  fields  are  covered  with  it,  and 
.cultivated  with  the  greatest  care.* 

*  The  origin  of  the  employment  of  tea  as  a  beverage  amongst 
•the  Chinese,  is  wrapped  in  the  obscurity  which  generally  be- 
longs to  ancient  usages  ;  and  a  fabulous  tale  is  narrated,  as  to 
its  introduction,  which  has  had  credence  even  amongst  the 
better  informed  inhabitants  of  the  empire,  whilst,  as  is  usual 
with  fables,  it  has  been  imagined  to  have  some  allegorical 
allusion,  which,  if  explained,  would  satisfy  the  lover  of  anti- 
quarian lore.  The  tale  is  thus  related  by  one  of  the  compilers 
of  a  history  of  China  :  — 

'  Darma,  a  very  religious  prince,  and  third  son  of  an  Indian 
king,  named  Kosjusvo,  is  said  to  have  landed  in  China,  in  the 
year  510  of  the  Christian  era.  He  employed  all  his  care  and 
thought  to  diffuse  throughout  the  country  a  knowledge  of  God 
and  religion  ;  and,  being  desirous  to  excite  men  by  his  exam- 
ple, imposed  on  himself  privations  and  mertifications  of  every 
kind,  living  in  the  open  air,  and  devoting  the  days  and  nights 


ON    COFFEE    AND    TEA.  299 

When  the  plants  have  attained  their  third 
year,  the  collection  of  the  leaves  is  commenced. 
It  is  repeated  every  year  until  the  trees  are 
seven  or  eight  years  old,  after  which  they  are 
cut  down,  that  they  may  shoot  up  afresh  from 
the  roots,  a  process  which  increases  the  quan- 
tity of  leaves. 

The  leaves  are  carefully  picked  oft',  one  by 
one.  In  Japan,  the  best  kind,  called  imperial 
tea,  is  collected  at  the  end  of  February,  or  the 
beginning  of  March,  before  the  leaves  are  fully 
unfolded.  This  tea  is  scarce  and  dear,  and  is 

to  prayer  and  contemplation.  After  several  years,  however, 
being  worn  out  with  fatigue,  he  fell  asleep  against  his  will  ; 
and,  that  he  might  faithfully  observe  his  oath,  which  he  thought 
he  had  violated,  he  cut  off  his  eyelids,  and  threw  them  on  the 
ground.  Next  day,  having  returned  to  the  same  spot,  he  found 
them  changed  into  a  shrub  which  the  earth  had  never  before 
produced.  Having  eaten  some  of  the  leaves  of  it,  he  found  his 
spirits  exhilarated  and  his  former  vigor  restored.  He  recom- 
mended this  aliment  to  his  disciples  and  followers.  The  repu- 
tation of  tea  increased,  and  after  that  time  it  continued  to  be 
generally  used.  Kaempfer,  in  his  Amanitates  Exotica,  gives 
the  life  with  a  portrait  of  this  saint,  so  celebrated  in  China 
and  Japan.  There  is  seen  at  the  feet  of  Darma  a  reed,  which 
indicates  that  he  had  traversed  the  seas  and  rivers.'  —  Sigmonl 
on  Tea,  p.  12. 


300  ON    COFFEE    AND    TEA. 

drunk  by  the  grandees  and  rich  people  only. 
The  second  gathering  is  made  a  month  later, 
taking  indiscriminately  the'  leaves  that  are  un- 
folded and  those  which  are  not.  Finally,  a 
month  after  this,  is  made  the  third  and  last 
gathering,  consisting  of  leaves  fully  grown, 
which  furnish  the  poorest  and  lowest  priced 
teas,  consumed  by  the  common  people.  It  is 
now  pretty  well  understood  that  the  different 
sorts  of  tea  imported  into  this  country,  from 
the  finest  green  teas  to  the  poorest  bohea,  de?- 
pend  for  their  difference  of  quality  very  much 
upon  the  time  of  their  gathering. 

The  process -of  gathering,  drying,  and  rolling 
the  leaves  is  very  laborious,  and  is  in  some 
instances  conducted  with  the  most  superfluous 
nicety.  In  Japan,  where  a  particular  mountain 
is  appropriated  to  raising  tea  for  the  exclusive 
use  of  the  emperor,  the  shrubs  are  washed  and 
cleansed  from  dust  every  day;  the  men  em- 
ployed in  gathering  the  leaves  are  obliged  to 
bathe  themselves  two  or  three  times  a  day,  and 
to  wear  gloves  in  the  performance  of .  their 
occupation. 

The  drying  and  rolling  of  the  leaves  is  per- 


ON    COFFEE    AND    TEA.  301 

formed  by  the  Chinese  in  buildings  erected 
for  general  use.  Several  pounds  of  the  leaves 
fresh  gathered  are  placed  in  a  large  shallow  pan 
of  thin  iron,  and  heated  over  a  furnace,  the  ope- 
rator shaking  and  turning  them  with  his  hands 
until  they  begin  to  crackle.  The  heat  thus  ap- 
plied deprives  the  leaves  of  their  juice,  and  with 
it  of  the  inebriating  and  deleterious  properties 
which  they  possess  while  green.  After  the 
leaves  are  thoroughly  roasted,  they  are  taken 
out  with  wooden  shovels  and  delivered  to  the 
rollers.  These  persons  roll  them  rapidly  and 
with  a  regular  motion,  with  the  palms  of  their 
hands,  upon  tables  covered  with  fine  mats,  until 
they  acquire  the  form  in  which  we  see  them 
imported.  This  operation  produces  an  almost 
insupportable  burning  in  the  hands,  which  is 
aggravated  by  a  yellowish  inflammatory  juice 
pressed  out  from  the  leaves.  Nevertheless,  it 
is  necessary  to  continue  the  operation  until  the 
leaves  are  completely  cold,  for  they  cannot  be 
rolled  except  when  hot,  and  in  order  that  they 
should  not  unroll,  it  is  necessary  that  they 
should  cool  under  the  hands.  The  more  rapid 


302  ON    COFFEE    AND    TEA. 

the  cooling,  the  better  they  are  rolled,  and  on 
this  account  the  workmen  agitate  the  air  with  a 
kind  of  fan  But,  in  spite  of  this  precaution,  a 
great  number  of  the  leaves  unroll  themselves, 
and  are  obliged  to  be  separated  and  roasted, 
and  rolled  several  successive  times  before  they 
are  in  order  to  be  packed. 

In  order  that  the  tea  should  keep  well,  it 
must  be  inclosed  in  vessels  which  are  air-tight. 
Ksempfer  assures  us  that  the  tea  brought  into 
Europe  is  always  injured  in  quality,  and  never 
retains  the  fine  flavor  and  delicate  perfume 
which  it  has  in  its  own  country.  The  Japanese 
inclose  their  tea  in  vessels  of  tin,  which,  if  large, 
are  placed  in  savin  boxes  having  their  cracks 
closed  with  paper  within  and  without.  The  tea 
imported  to  this  country  from  China,  it  is  well 
known,  comes  in  tight  wooden  chests,  lined 
with  sheet  lead  hermetically  soldered.  It  is 
packed  in  these  chests  by  the  Chinese,  by 
stamping  it  down  with  their  bare  feet. 

Some  writers  have  asserted  that  the  tea  is 
roasted  upon  plates  of  copper,  and  that  its  color 
is  owing  to  verdigris,  with  which  it  thus  be- 


ON    COFFEE    AND    TEA.  303 

comes  impregnated.  But  those  travellers  who 
are  most  entitled  to  credit,  affirm  that  the  plates 
are,  without  exception  of  iron;  and  Dr.  Lettson, 
after  a  great  number  of  experiments  made  with 
chemical  tests,  never  detected  any  trace  of  cop- 
per ;  so  that  this  suspicion  appears  to  be  void  of 
foundation. 

Among  the  Chinese  tea  is  drunk  in  a  variety 
of  ways.  Some  use  it  as  we  do,  in  the  form  of 
an  infusion ;  others  take  it  in  the  form  of  fine 
powder  mixed  with  boiling  water.  The  com- 
mon or  laboring  people  are  said  to  use  it  in 
decoction,  several  handfuls  of  the  ordinary  kinds 
of  tea  being  boiled  in  a  kettle  of  water  until  the 
strength  is  extracted.  This  is  taken  by  them  as 
their  common  drink  for  assuaging  thirst,  and 
diluting  meals. 

Tea  was  first  introduced  into  Europe  by  the 
Dutch,  before  the  middle  of  the  seventeenth 
century,  and  several  physicians  of  eminence, 
either  from  conviction  of  its  utility,  or  per- 
haps for  the  more  substantial  reason  of  a 
pecuniary  reward,  published  warm  eulogies  in 
its  favor.  From  this  time  its  adoption  was 
rapid  in  all  the  countries  of  Europe,  and  it  is 


304  ON    COFFEE    AND    TEA. 

now  a  common  article  of  diet  with  both  rich 
and  poor.* 

*  Nicolaus  Tulpius  was  about  the  first  medical  man  who 
wrote  professionally  upon  tea,  but  his  were  not  original  obser- 
vations ;  they  were  the  opinions  of  the  most  eminent  men  he 
had  collected  to  give  to  the  world.  But  in  1678  appeared  the 
first  edition  of  a  book  which  speedily  ran  through  three  large 
impressions,  and  had  a  considerable  influence  upon  the  intro- 
duction of  tea.  It  was  entitled  Cornelia  Bontekoe,  Tractaat 
van  he.t  excellence  Kruyd  Thee.  Although  this  work  was, 
from  the  extravagance  of  its  commendations  on  tea,  severely 
kandled  by  some  of  the  critics,  it  was  translated  into  many  lan- 
guages, and  quoted  as  the  highest  authority.  He  pronounced 
tea  to  be  the  infallible  cause  of  health,  and  that  if  mankind 
could  be  induced  to  drink  a  sufficient  quantity  of  it,  the  innu- 
merable ills  to  which  man  is  subject  would  not  only  be  dimin- 
ished, but  entirely  unknown.  He  thinks  that  two  hundred  cups 
daily  would  not  be  too  much.  He  is  said  to  have  been  rewarded 
for  his  judgment  by  the  liberality  of  the  Dutch  East  India  Com- 
pany. Heydentrik  Overcamp,  who  wrote  the  life  of  Bontekoe, 
states  that  his  inducement  to  write  was  to  recommend  himself  to 
his  fellow-citizens,  and  to  defend  himself  against  his  colleagues, 
who  did  not  follow  his  theory  or  his  practice.  Etmuller  recom- 
mended tea  as  a  fine  stomachic  cephalic  and  antinephritic. 
Pechlin  wrote  a  dialogue  on  tea,  which  he  entitled  Theojihi/us 
Bibaculus,  and  several  poets  indulged  themselves  in  its  praise. 
Petit  wrote  a  poem  ;  Peter  Francius,  two  Anacreontics  ;  Hein- 
rich,  a  Doric  Melydrion  ;  and  our  poet-laureate,  Tate,  joined  the 
melodious  bards.  Whilst  it  met  with  so  much  approbation,  there 


ON    COFFEE    AND    TEA.  305 

In  regard  to  the  medicinal  qualities  of  tea, 
and  its  general  influence  upon  the  health  of 
those  who  take  it,  reports  and  opinions  are 


were  likewise  those  who  were  not  equally  satisfied  with  its 
merits.  Boerhaave,  Van  Swieten,  and  others,  attempted  to  stem 
the  tide  that  was  setting  in  its  favor,  but  they  have  proved 
themselves  incapable  of  resisting  the  general  impression  ;  for 
no  beverage  that  has  ever  yet  been  introduced  sits  so  agreeably 
on  the  stomach,  so  refreshes  the  system,  soothes  nervous  irrita- 
tion after  fatigue,  or  forms  a  more  grateful  repast.  It  contrib- 
utes to  the  sobriety  of  a  nation  ;  it  imparts  all  the  charms  to 
society  which  spring  from  the  enjoyment  of  conversation,  with- 
out that  excitement  which  follows  upon  a  fermented  drink.  — 
Sigmond,  p.  94. 

The  introduction  of  tea-drinking  into  England  has  been  as- 
cribed to  Lord  Arlington  and  Lord  Orrery,  and  the  year  1666r 
the  anntis  mirabilis  of  Dryden,  has  been  assigned  as  the  exact 
date  ;  but  in  the  diary  of  Mr.  Pepys,  secretary  to  the  Admi- 
ralty, the  following  is  registered,  —  '  I  sent  for  a  cup  of  tea,  a 
Chinese  drink,  of  which  I  had  never  drank  before.'  In  the 
diary  of  Henry,  Earl  of  Clarendon,  there  is  a  memorandum, — 
« Pere  Couplet  supped  with  me,  and  after  supper  we  had  tea, 
which  he  said  was  really  as  good  as  any  he  drank  in  China.' 
The  first  historical  record,  however,  is  an  act  of  Parliament,, 
passed  in  the  year  1660,  12  Carl.  II.  c.  23,  which  enacts  that  a 
duty  should  be  laid  of  eight  pence  per  gallon  on-  all  tea  made 
and  sold  in  coffee-houses  j  which  were  visited  twice  daily  by 

20 


306 


ON    COFFEE    AND    TEA. 


various  and  contradictory.  Such  is  the  diver- 
sity of  temperaments  and  constitutions,  that  it 
cannot  otherwise  happen  than  that  an  article  of 


officers,  whose  duty  it  was  to  ascertain  what  quantity  had  been 
made. 

From  An  exact  Description  of  the  Growth,  Quality,  and 
'Virtues  of  the  Leaf  Tea,  by  Thomas  Garway,  in  Exchange 
Alley,  near  the  Royal  Exchange,  in  London,  Tobacconist, 
and  Seller  and  Retailer  of  Tea  and  Coffee  ;  published  about 
1660. 

'  Tea  is  generally  brought  from  China,  and  groweth  there 
upon  little  shrubs  and  bushes,  the  branches  whereof  are  well 
garnished  with  white  flowers,  that  are  yellow  within,  of  the  big- 
ness and  fashion  of  sweet-brier,  but  in  smell  unlike,  bearing 
thin  green  leaves,  about  the  bigness  of  scordium,  myrtle,  or 
euinack,  and  is  judged  to  be  a  kind  of  sumack.  The  said  leaf 
is  of  such  known  virtues,  that  those  very  nations,  so  famous  for 
antiquity,  knowledge,  and  wisdom,  do  frequently  sell  it  among 
themselves  for  twice  its  weight  in  silver  ;  and  the  high  estima- 
tion of  the  drink  made  therewith  hath  occasioned  an  inquiry 
into  the  nature  thereof,  amongst  the  most  intelligent  persons  of 
all  nations  that  have  travelled  in  those  parts,  who,  after  exact 
tryal  and  experience  by  all  wayes  imaginable,  have  commended 
it  to  the  use  of  their  several  countries,  and  for  its  virtues  and 
operations,  particularly  as  followeth,  viz.  — 

'  The  quality  is  moderately  hot,  proper  for  winter  and  sum- 
mer. The  drink  is  declared  to  be  most  wholesome,  preserving 
in  perfect  health  until  extreme  old  age. 


ON    COFFEE    AND    TEA.  307 

diet  which  is  taken  by  one  person  with  impu- 
nity, and  even  with  benefit,  shall  in  another 
occasion  disagreeable  and  even  serious  conse- 


4  The  particular  virtues  are  these  :  — 

'  It  maketb.  the  body  active  and  lusty. 

'  It  helpeth  the  headache,  giddiness  and  heaviness  thereof. 

'  It  removeth  the  obstructions  of  the  spleen. 

'  It  taketh  away  the  difficulty  of  breathing,  opening  obstruc- 
tions. 

'It  is  good  against  tipitude,  distillations,  and  cleareth  the 
sight. 

4  It  removeth  lassitude,  and  cleanseth  and  purifieth  acrid  hu- 
mors, and  a  hot  liver. 

4  It  is  good  against  crudities,  strengthening  the  weakness  of 
the  ventricle  or  stomach,  causing  good  appetite  and  digestion, 
and  particularly  for  men  of  corpulent  body,  and  such  as  are 
great  eaters  of  flesh. 

4  It  vanquisheth  heavy  dreams,  easeth  the  frame,  and  strength- 
eneth  the  memory. 

'  It  overcometh  superfluous  sleep,  and  prevents  sleepiness  in 
general,  a  draught  of  the  infusion  being  taken  ;  so  that,  without 
trouble,  whole  nights  may  be  spent  in  study  without  hurt  to  the 
body,  in  that  it  moderately  healeth  and  bindeth  the  mouth  of  the 
stomach. 

4  It  prevents  and  cures  agues,  surfets  and  fevers,  by  infusing 
a  fit  quantity  of  the  leaf,  thereby  provoking  a  most  gentle  vomit 
and  breathing  of  the  pores,  and  hath  been  given  with  wonderful 
success. 


308  ON    COFFEE    AND    TEA. 

quences.  Dr.  Cullen  considered  tea  as  decid- 
edly narcotic  and  sedative  in  its  effects ;  but 
the  most  superficial  observer  must  see  that  tea 


'  It  (being  prepared  and  drank  with  milk  and  water)  strength- 
eneth  the  inward  parts,  and  prevents  consumption  ;  and  power- 
fully assuageth  the  pains  of  the  bowels,  or  griping  of  the  guts, 
and  looseness. 

'  And  that  the  virtues  and  excellences  of  this  leaf  and  drink 
are  many  and  great,  is  evident  and  manifest  by  the  high  esteem 
and  use  of  it  (especially  of  late  years)  among  the  physicians  and 
knowing  men  of  France,  Italy,  Holland,  and  other  parts  of 
Christendom  ;  and  in  England  it  hath  been  sold  in  the  leaf  for 
six  pounds,  and  sometimes  for  ten  pounds  the  pound  weight ; 
and  in  respect  of  its  former  scarceness  and  dearness,  it  hath  been 
only  used  as  a  regalia  in  high  treatments  and  entertainments, 
and  presents  made  thereof  to  princes  and  grandees  till  the  year 
1657.  The  said  Thomas  Garway  did  purchase  a  quantity  there- 
of, and  first  publicly  sold  the  said  tea  in  leaf  and  drink,  made 
according  to  the  directions  of  the  most  knowing  merchants  and 
travellers  in  those  eastern  countries  ;  and  upon  knowledge  and 
experience  of  the  said  Garway's  continued  care  and  industry  in 
obtaining  the  best  tea,  and  making  drink  thereof,  very  many 
noblemen,  physicians,  and  merchants,  and  gentlemen  of  quality, 
have  ever  since  sent  to  him  for  the  said  leaf,  and  daily  resort  to 
his  house  in  Exchange  Alley  aforesaid,  to  drink  the  drink 
thereof. 

1  And  that  ignorance  nor  envy  may  have  no  ground  or  power 
to  report,  or  suggest,  that  what  is  here  asserted,  of  the  virtues 


ON    COFFEE    AND    TEA.  309 

has  very  little  in  common  with  other  narcotics. 
The  excitement  which  it  produces  upon  the 
mind  and  upon  the  organs  of  digestion  is  of  a 
durable  and  permanent  kind,  and  it  never,  like 
other  narcotics,  leaves  the  system  in  a  state  of 
somnolency  and  intoxication.  These  remarks 
are  to  be  understood  of  tea  in  the  state  in  which 
we  consume  it,  that  is,  the  state  of  perfect  dry- 
ness.  In  its  green  or  recent  state,  it  is  said  to 
possess  a  decided  narcotic  quality,  capable  of 
producing  intoxication  and  other  deleterious 


and  excellences  of  this  precious  leaf  and  drink,  hath  more  of 
design  than  truth,  for  the  justification  of  himself  and  the  satis- 
faction of  others,  he  hath  here  enumerated  several  authors, 
who,  in  their  learned  works,  have  expressly  written  and  asserted 
the  same  and  much  more,  in  honor  of  this  noble  leaf  and  drink, 
Tiz.  —  Bontius,  Riccius,  Jarricus,  Almeyda,  Horstius,  Alvarez 
Semeda,  Martinivus  in  his  China  Atlas,  and  Alexander  de 
Rhodes  in  his  Voyage  and  Missions,  in  a  large  discourse  of  the 
ordering  of  this  leaf,  and  the  many  virtues  of  the  drink ;  printed 
at  Paris,  1653,  part  x.  chap.  13. 

« And  to  the  end  that  all  persons  of  eminency  and  quality, 
gentlemen  and  others,  who  have  occasion  for  tea  in  leaf,  may  be 
supplyed,  these  are  to  give  notice,  that  the  said  Thomas  hath 
tea  to  sell,  from  sixteen  to  fifty  shillings  in  the  pound.'  —  Sig- 
mond,  p.  96,  &c. 


310 


ON    COFFEE    AND    TEA. 


consequences.  This  property,  however,  is  of  a 
volatile  nature,  and  is  lost  in  the  process  of 
drying  and  by  a  few  months'  age. 

A  crystalline,  volatile,  salefiable  substance 
has  been  found  in  tea  by  chemists,  and  by  them 
named  Theine.  It  is  said  to  exist  in  combina- 
tion with  tannic  acid  in  the  leaves,  and  to  be 
identical  in  its  chemical  composition  with  caf- 
feine, the  alkaloid  found  in  coffee.  Its  chemical 
character  has  led  Liebig  to  suppose  that,  when 
used  as  an  article  of  diet,  it  may  promote  the 
formation  of  taurine,  a  peculiar  compound  in 
the  bile. 

Tea,  as  it  is  brought  to  us  in  its  dry  state, 
has  the  effect  of  creating  a  lightness  and  ex- 
hilaration of  mind,  an  increased  action  of  the 
stomach  in  the  process  of  digestion,  and,  above 
all,  a  vigilance  and  increased  power  of  mental 
exertion.  Dr.  Johnson  is  recorded  to  have  made 
the  teapot  the  companion  of  his  lucubrations, 
and  to  have  taken  immense  quantities  of  its 
contents,  to  sustain  the  energies  of  his  powerful 
mind  during  the  prodigious  labors  which  he 
accomplished.  In  its  other  properties  tea  is 
astringent  and  antiseptic.  It  visibly  produces 


ON    COFFEE    AND    TEA.  311 

no  injurious  effect  upon  the  generality  of  per- 
sons who  take  it  from  infancy  to  old  age.  It 
is  remarked  by  Desfontaines,  that  no  vegetable 
is  known,  the  infusion  of  which  can  be  drunk 
so  often  and  in  such  large  quantities,  without 
disgust.  The  Chinese  regard  it  as  highly  salu- 
brious. They  mix  with  it  neither  milk  nor 
sugar,  but  drink  it  pure,  sometimes  holding  a 
piece  of  sugar  in  the  mouth.  The  constant 
use  which  this  people  have  made  of  it  for  so 
many  ages  seems  to  prove  that,  when  rightly 
prepared,  it  is  destitute  at  least  of  injurious 
properties.  Professor  Kalm  states,  that  tea  is 
the  best  corrector  of  bad  water,  and  that  he 
derived  from  it  great  comfort  and  benefit  dur- 
ing the  illness  and  inconvenience  of  a  long  sea 
voyage.  It  is,  in  fact,  one  of  the  best  remedies 
for  slight  sea-sickness.  An  extract  made  of 
tea  is  in  high  repute  as  a  medicine  in  China, 
and  is  said  to  remove  obstructions  and  pro- 
mote perspiration.  Dr.  Lettsom  found  that 
tea  given  in  fine  powder,  in  doses  of  thirty 
grains  once  in  three  or  four  hours,  produced 
nausea  and  diaphoresis,  and  appeared  to  di- 
minish the  heat  accompanying  inflammatory 


312  ON    COFFEE    AND. TEA. 

complaints.     The  finer  and  more  green  is  the 
tea,  the  more  powerful  are  its  specific  effects. 

Nevertheless,  a  variety  of  injurious  conse- 
quences have  been  ascribed  to  tea,  and  many 
no  doubt  have  arisen,  either  from  its  abuse,  or 
from  the  idiosyncrasies  of  those  who  have  been 
the  subjects  of  its  influence.  Some  persons 
complain  that,  after  taking  freely  of  tea,  a  ner- 
vous agitation  of  the  whole  frame  commences. 
The  hands  tremble,  so  as  to  be  incapable  of 
writing ;  the  limbs  experience  a  loss  of  power, 
and  perform  their  office  with  difficulty ;  at  the 
same  time  a  confusion  of  ideas  incapacitates 
the  mind  for  any  close  or  active  train  of  think- 
ing. There  are  even  some  persons,  in  whom 
tea  produces  great  nausea  and  sickness,  with 
spasmodic  pains  of  the  stomach  and  bowels, 
and  an  uncontrollable  agitation  of  spirits  on  the 
least  hurry,  noise  or  disturbance.  These  symp- 
toms, however,  are  the  effect  of  some  peculiarity 
in  the  constitution,  a  great  mobility  of  the  ner- 
vous system,  and  generally  of  a  slender,  en- 
feebled and  effeminate  frame.  They  may,  how- 
ever, arise  in  all  persons  from  an  excessive  use, 
either  as  it  respects  the  quantity  or  strength  of 


ON    COFFEE    AND    TEA.  313 

the  tea,  or  the  want  of  nourishment  taken  at 
the  same  time.  I  believe  the  number  of  per- 
sons will  be  found  to  be  exceedingly  small,  who 
cannot  take  tea  in  moderate  quantities  and  ac- 
companied by  food,  without  any  inconvenience 
whatever. 

The  inquiry  is  very  often  made  of  physicians, 
Which  is  the  most  wholesome  article  of  food, 
coffee  or  tea  ?  The  prejudices  of  most  persons 
are  ranged  on  one  side  or  the  other  of  this  ques- 
tion, and  even  practitioners  themselves  are  apt 
to  fall  into  one  or  the  other  extreme.  One  of 
the  oldest  and  most  distinguished  physicians  of 
this  city,*  being  asked  what  was  the  difference 
in  effect  between  tea  and  coffee,  replied,  that 
'  One  is  poison,  and  the  other  not.'  A  physi- 
cian of  equal  eminence,  in  Philadelphia,!  de- 
cided on  the  properties  of  the  two  with  equal 
positiveness,  taking,  however,  the  opposite  side 
of  the  question.  The  truth  is,  that  there  are 
scarcely  any  two  substances  in  the  materia 
medica  which  bear  a  closer  relation,  or  more 
nearly  resemble  each  other,  in  their  properties, 

*  Dr.  S.  Danforth.  t  !>*•  B-  s-  Barton. 


314 


ON    COFFEE    AND    TEA. 


than  coffee  and  tea.  Tea  is  more  astringent 
than  coffee,  and  coffee  of  the  strength  com- 
monly used  is  somewhat  more  stimulating 
than  tea,  —  otherwise  the  differences  which 
have  been  ascribed  to  them  have  mostly  arisen 
from  the  accidental  opinions  of  individuals, 
whose  taste  and  idiosyncrasies  have  rendered 
them  fond  of  the  one  and  averse  to  the  other. 


REPORT 

ON   THK 

ACTION   OF    COCHITTJATE  WATER 
ON  LEAD  PIPES; 

AND     THE     INFLUENCE     OF    THE    SAME    ON    HEALTH. 
[From  the  American  Journal  of  Medical  Sciences  for  1852.] 

THE  committee  appointed  by  the  Society  of 
Medical  Improvement  in  Boston,  for  investiga- 
ting the  question  of  the  occurrence  6f  any  dis- 
eases attributable  to  the  presence  of  lead  in  the 
aqueduct  water  introduced  into  the  city,  from 
the  Cochituate  Lake,  report  as  follows:  — 

That  from  an  extensive  inquiry  among  physi- 
cians, and  also  from  the  bills  of  mortality,  they 
are  led  to  believe  that  the  health  of  the  city  of 
Boston  has  been  uncommonly  good  during  seve-  • 
ral  years  since  the  introduction  of  Cochituate 
water,  —  and  they  have  not  learned  that  any 


316 


ACTION    OF    COCHITUATE    WATER 


well-marked  cases  of  the  diseases  usually  attrib- 
uted to  lead,  have  occurred,  which  were  not 
traceable  to  some  other  cause  than  the  use  of 
Cochituate  water  drawn  from  leaden  pipes. 

It  appears  from  the  experiments  of  Professor 
Horsford,  that  the  water  of  the  Schuylkill  and 
Croton  rivers,  and  of  Jamaica  and  Cochituate 
lakes,  acts  upon  the  surface  of  the  lead  so  as  to 
take  up  a  small  portion  of  that  metal  during  the 
first  two  or  three  days  of  its  contact.  But  after 
a  few  days  the  surface  of  the  lead  becomes  coat- 
ed with  an  insoluble  compound  which  protects 
the  lead  for  the  most  part  from  the  further 
action  of  the  water.  Nevertheless,  traces  of  lead 
are  reported  to  have  been  found  by  various 
chemists  in  specimens  of  some  of  these  waters, 
when  greatly  reduced  by  evaporation. 

In  consequence  of  the  extensive  use  made  of 
lead  for  various  economical  purposes,  no  person 
in  civilized  society  can  expect  to  escape  from 
the  reception  of  that  metal  in  minute  quantities 
into  the  body.  The  presence  of  lead  in  the 
paint  of  dwelling-houses  and  furniture,  of  water- 
buckets  and  other  culinary  apparatus,  in  vessels 
made  of  leaden  alloys  or  soldered  with  the  same, 


ON    LEAD    PIPES.  317 

in  the  lining  of  tea-chests,  in  flint-glass,  and  in 
the  glazing  of  coarse  pottery,  furnishes  but  a 
part  of  the  examples  which  indicate  our  expo- 
sure to  receive  this  metal  in  our  daily  food.  To 
these  examples  it  may  be  added  that  physicians 
give  lead  to  their  patients  sometimes  for  weeks 
successively,  and  apply  solutions  and  solid  com- 
pounds of  the  metal  to  absorbing  surfaces  for 
longer  periods ;  that  persons  are  known  to  carry 
shot  and  bullets  in  their  flesh  during  a  long  life ; 
and,  finally,  that  reliable  chemists  testify  that 
lead  naturally  exists  in  the  solids  and  fluids  of 
man,  and  in  those  of  some  of  the  animals  on 
which  he  feeds. 

From  all  these  facts  we  are  authorized  to 
draw  the  conclusion  that  in  the  present  state  of 
our  knowledge,  the  presence  of  lead  in  a  very 
minute  amount,  like  the  presence  of  other  sub- 
stances in  infinitesimal  quantities,  is  inopera- 
tive upon  the  living  body. 

It  is  a  general  law  known  to  medical  men, 
and  to  which  there  are  not  many  exceptions, 
that  diseases  and  symptoms  produced  by  speci- 
fic metallic  agents,  such  as  mercury,  lead,  and 
arsenic,  do  not  cease  until  after  the  withdrawal 


318  ACTION    OF    COCIIITUATE    WATER 

of  those  agents.  But  it  appears  from  the  re- 
cords  of  the  Massachusetts  General  Hospital, 
during  the  last  twenty  years,  as  well  as  from 
the  private  experience  of  physicians,  that  many 
cases  of  lead  colic  and  paralysis,  acquired  by 
persons  who  work  in  that  metal,  have  got  well 
under  the  daily  use  of  water  delivered  from 
leaden  pipes.  This  would  not  probably  have 
been  the  case  did  the  water  contain  any  delete- 
rious amount  of  lead  in  solution  or  suspension. 
The  principal  diseases  ascribed  by  Tanquerel, 
and  some  subsequent  writers,  to  the  presence  of 
lead,  are  colic,  paralysis,  arthralgia,  and  ence- 
phalopathy.  Of  these  the  committee  have  not 
been  able  to  learn  that  there  has  been  any  sen- 
sible increase  in  this  city  since  the  introduction 
of  Cochituate  water.  Of  lead  colic,  but  one 
case  has  entered  the  hospital  during  the  last 
two  years,  which  is  a  smaller  proportion  than 
the  average  of  the  preceding  twenty  years.  Of 
lead  paralysis  there  have  been  but  two  cases 
within  the  same  period,  both  occurring  to  work- 
men in  lead.  Of  arthralgia  or  pain  in  the  joints 
or  limbs  directly  traceable  to  lead,  it  is  believed 
there  have  not  been  a  sufficient  number  of  cases 


ON    LEAD    PIPES.  319 

at  any  time  to  attract  extensively  the  notice  of 
our  physicians.  As  to  encephalopathy,  a  gene- 
ral term  used  by  some  writers  to  express  cerebral 
disease,  and  including  coma,  delirium,  convul- 
sions, &c.,  there  is  apparently  no  more  reason 
for  attributing  it  to  lead,  than  consumption, 
fever,  or  any  other  common  disease  which  may 
happen  to  occur  among  lead  workmen. 

It  is  obvious  to  a  medical  reader,  that  many 
of  the  cases  detailed  by  writers  on  lead  diseases 
are  coincidences  rather  than  consequences  ;  and 
therefore  do  not  furnish  a  ground  for  general 
laws.  Such  is  the  case  when  persons  have  been 
supposed  to  have  contracted  lead  diseases  by 
sleeping  in  newly-painted  apartments,  where, 
unless  the  lead  were  volatile,  it  could  not  leave 
the  walls  to  enter  the  bodies  of  the  patients.  It 
is  also  the  case  when  solitary  examples  of  com- 
mon diseases  are  ascribed  to  lead,  when  it  is 
known  that  they  more  frequently  result  from 
different  causes.  It  is  also  often  the  case  when 
the  reports  of  credulous  and  incompetent  ob- 
servers are  received  as  scientific  authority. 

In  a  late  '  English  Report  by  the  Government 
Commissioners  on  the  Chemical  Quality  of  the 


320  ACTION    OF    COCHITUATE    WATER 

Supply  of  Water  to  the  Metropolis,'  of  London, 
made  in  1851,  by  Drs.  Th.  Graham,  W.  A.  Mil- 
ler, and  A.  W.  Hoffman,  men  of  high  standing 
in  the  scientific  world,  an  investigation  is  made 
of  the  condition  of  the  various  waters  now 
supplied  to  that  city.  In  this  Report,  the  com- 
missioners state  (page  32)  that  'no  recent  or 
authenticated  case  can  be  cited  of  the  health  of 
any  of  the  numerous  towns  lately  supplied  with 
soft  water,  being  affected  by  the  use  of  leaden 
distributing  tubes.'  Again,  on  page  33,  the 
commissioners  say :  '  We  are  disposed,  there- 
fore, to  conclude  that  the  danger  from  lead  in 
towns  supplied  with  water,  has  been  overrated  ; 
and  that,  with  a  supply  from  the  Water  Com- 
panies, not  less  frequent  than  daily,  no  danger 
is  to  be  apprehended  from  the  use  of  the  present 
distributing  apparatus,  with  any  supply  of  mod- 
erately soft  water  which  the  metropolis  is  likely 
to  obtain.' 

On  the  present  occasion  it  is  by  no  means 
intended  to  deny  the  well-known  fact,  that  cer- 
tain acid  liquors,  also  that  the  water  of  certain 
springs  and  wells,  may  and  do  act  upon  and 
even  dissolve  lead  in  such  quantities  as  to  prove 


ON    LEAD    PIPES.  321 

injurious  to  human  health.  It  is  also  possible 
that  at  certain  seasons,  and  under  certain  cir- 
cumstances, the  soft  water  of  lakes  and  rivers 
may  contain  organic  or  other  products,  which 
may  take  up  in  solution  a  minute  portion  of 
the  pipes  through  which  they  pass.  And  it  may 
even  be  conceded  as  possible,  that  a  few  suscep- 
tible and  predisposed  individuals  will  get  lead 
diseases  while  using  this  water.  Nevertheless, 
lead  is  a  very  convenient  material  to  be  used  in 
aqueducts.  It  is  more  cheaply  manufactured, 
more  conveniently  applied,  and  more  readily 
repaired,  than  any  other  material.  And  while 
this  is  the  case,  mankind  will  not  be  prevented 
from  employing  it.  The  general  law  derived 
from  the  experience  of  the  large  cities  of  this 
country  and  of  Europe  is,  that  its  employment 
for  the  conveyance  of  soft  water  is  safe.  To 
this  law  the  few  recorded  cases  of  disease,  if 
genuine,  must  be  regarded  as  exceptions.  And 
it  should  be  borne  in  mind,  that  nearly  all  the 
great  agents  which  minister  to  the  physical  hap- 
piness and  improvement  of  man,  are  fraught 
with  more  or  less  danger.  Ships  and  railroads, 
fire  and  water,  food,  drink  and  medicine  destroy 
21 


322  ACTION    OF    COCHITUATE    WATER. 

annually  multitudes  of  our  species.  Neverthe- 
less, all  these  agents  increase  every  year  in  use, 
with  the  increase  of  wealth  and  civilization. 
And  as  a  humble  example  under  the  same  law, 
it  is  not  probable  that  the  leaden  aqueduct  will 
be  abandoned,  on  account  of  the  inconsider- 
able risk  which  it  may  involve  of  occasioning 
disease.  From  the  present  state  of  our  knowl- 
edge, we  are  authorized  to  conclude  that  the  in- 
surance on  a  citizen  of  Boston,  New  York,  Phil- 
adelphia, or  London,  against  lead  colic,  is 
probably  worth  much  less  than  his  insurance 
would  be  on  a  voyage  across  the  Atlantic,  or 
on  a  railroad  for  twenty  miles. 


ON  THE 

HISTORY  AND  USE  OF  TOBACCO. 

MOSTLY  FROM  THE  AMERICAN   MEDICAL   BOTANY,   VOL.   I. 

IT  is  a  remarkable  law  of  the  animal  economy, 
that  the  power  of  use  and  habit  is  capable  of 
reconciling  the  system  to  bear  with  impunity 
what  in  its  unaccustomed  state  proves  deleteri- 
ous or  even  fatal.  It  is  a  fact  that  many  sub- 
stances in  the  Materia  Medica  lose  their  effect 
after  the  continuance  of  their  use  for  a  certain 
length  of  time,  so  that  if  we  would  realize  their 
original  operation,  we  must  increase  their  dose 
in  proportion  as  the  body  becomes  accustomed 
and  insensible  to  their  stimulus.  This  is  par- 
ticularly exemplified  in  the  narcotics.  Several 
of  these  substances,  which  at  first  are  not  only 
nauseous  and  disgusting  in  their  sensible  quali- 
ties, but  highly  injurious  in  their  influence  upon 


324  HISTORY    AND    USE    OF    TOBACCO. 

health,  are  so  changed  in  their  effect  by  habit- 
ual use,  as  to  become  to  those  who  employ 
them  an  indispensable  comfort  and  a  first-rate 
luxury  of  life. 

In  its  external  and  sensible  properties,  there 
is  no  plant  which  has  less  to  recommend  it  than 
the  common  tobacco.  Its  taste  in  the  green 
state  is  acrid,  nauseous  and  repulsive,  and  a 
small  quantity  taken  into  the  stomach  excites 
violent  vomiting,  attended  with  other  alarming 
symptoms.  Yet  the  first  person  who  had  cour- 
age and  patience  enough  to  persevere  in  its  use, 
until  habit  had  overcome  his  original  disgust, 
eventually  found  in  it  a  pleasing  sedative,  a 
soother  of  care,  and  a  material  addition  to  the 
pleasures  of  life.  Its  use,  which  originated 
among  savages,  has  spread  into  every  civilized 
country ;  it  has  made  its  way  against  the  de- 
clamations of  the  learned,  and  the  prohibitions 
of  civil  and  religious  authority,  and  it  now  gives 
rise  to  an  extensive  branch  of  agriculture,  or  of 
commerce,  in  every  part  of  the  globe. 

Tobacco  was  in  use  among  the  aborigines  of 
America,  at  the  time  of  its  discovery.  They 
employed  it  as  incense  in  their  sacrificial  fires, 


HISTORY    AND    USE    OF    TOBACCO.  325 

believing  that  the  odor  of  it  was  grateful  to 
their  gods.  The  priests  of  some  tribes  swallow- 
ed the  smoke  of  this  plant  to  excite  in  them  a 
spirit  of  divination,  and  this  they  did  to  a  de- 
gree which  threw  them  into  a  stupor  of  many 
hours'  continuance.  When  recovered  from  this 
fit  of  intoxication,  they  asserted  that  they  had 
held  a  conference  with  the  devil,  and  had  learn- 
ed from  him  the  course  of  future  events.  Their 
physicians  also  got  inebriated  with  the  smoke, 
and  pretended  that  while  under  the  influence  of 
this  intoxication  they  were  admitted  to  the 
council  of  the  gods,  who  revealed  to  them  the 
event  of  diseases. 

In  1559,  tobacco  was  sent  into  Spain  and 
Portugal  by  Hernandez  de  Toledo,  and  from 
thence  it  was  carried  into  France  as  a  curiosity 
by  Jean  Nicot  or  Nicotius,  ambassador  at  the 
court  of  Lisbon,  whose  name  is  now  immortal- 
ized by  its  application  to  this  genus  of  plants. 
From  this  period  the  use  of  tobacco  spread 
rapidly  through  the  continent,  and  in  half  a 
century  it  was  known  in  most  countries  in  Eu- 
rope. The  rich  indulged  in  it,  as  a  luxury  of 
the  highest  kind  ;  and  the  poor  gave  themselves 


326  HISTORY    AND    USE    OF    TOBACCO. 

up  to  it,  as  a  solace  for  the  miseries  of  life.  Its 
use  became  so  general  and  so  excessive,  that  in 
many  countries  the  constituted  authorities,  both 
of  church  and  state,  found  it  necessary  to  inter- 
pose, and  to  stop  the  extravagant  indulgence  in 
it  by  severe  prohibitions.  James  the  First  of 
England,  besides  writing  a  book  against  it, 
called  his  '  Counterblast  to  Tobacco,'  gave 
orders  that  no  planter  in  Virginia  should  cul- 
tivate more  than  one  hundred  pounds.  Pope 
Urban  the  Eighth  published  a  decree  of  excom- 
munication against  all  who  took  snuff  in  the 
church.  Smoking  was  forbidden  in  Russia 
under  penalty  of  having  the  nose  cut  off.  In 
Switzerland  a  tribunal  ( Chambre  du  tabac]  was 
instituted  for  the  express  purpose  of  trying 
transgressors  in  tobacco.  A  Turk,  who  was 
found  smoking  in  Constantinople,  was  conduct- 
ed through  the  streets  of  that  city  with  his  pipe 
transfixed  through  his  nose. 

Even  in  this  country,  where  the  use  of  to- 
bacco originated,  we  find  our  puritanic  ances- 
tors guarding  against  its  abuse  by  salutary 
statutes.  In  the  old  Massachusetts  colony  laws 
is  an  act  laying  a  penalty  upon  any  one  '  who 


HISTORY    AND    USE    OF    TOBACCO.  327 

shall  smoke  tobacco  within  twenty  poles  of  any 
house  ;'  or  who  shall  'take  tobacco  in  any  inn 
or  common  victualling  house,  except  in  a  pri- 
vate room,  so  as  that  neither  the  master  of  the 
said  house  nor  any  other  guest  shall  take  offence 
thereat.'  In  the  earliest  records  of  Harvard 
University  soon  after  its  foundation,  is  a  regula- 
tion of  this  kind  :  '  No  scholar  shall  take  tobac- 
co, unless  permitted  by  the  president,  with  the 
consent  of  their  parents  and  guardians,  and  on 
good  reason  first  given  by  a  physician,  and  then 
in  a  sober  and  private  manner.' 

While  the  legal  authorities  in  various  parts  of 
the  world  took  upon  them  to  control  the  abuse 
of  this  fascinating  weed,  the  literati  of  different 
countries  entered  warmly  into  the  discussion  of 
its  merits  and  its  faults.  Among  its  advocates 
were  Castor  Duranti  and  Raphael  Thorius,  both 
of  whom  wrote  Latin  poems  expressly  in  its 
praise.  The  performance  of  the  latter  is  entitled 
a  *  Hymn  to  Tobacco,'  and  is  very  lavish  in 
ascriptions  to  this  plant,  which  he  styles  the 
'  gift  of  heaven  and  the  ornament  of  earth.'  So 
warm  were  the  prejudices  of  its  advocates,  that 
it  obtained  the  reputation  of  a  general  panacea, 


328 


HISTORY    AND    USE    OF    TOBACCO. 


•and  the  catalogue  of  diseases  which  it  was 
announced  to  cure,  amounted  almost  to  a 
•complete  nosology. 

But  the  opinions  of  its  adversaries  were  not 
less  extravagant  upon  the  other  extreme.  It  is 
remarkable  that  in  the  days  of  its  first  general 
introduction,  no  man  spoke  about  it  with  cool- 
ness and  indifference,  but  every  one  warmly 
espoused  its  censure  or  its  praise.  Camden,  in 
his  Life  of  Queen  Elizabeth,  says,  that  men  used 
tobacco  every  where,  some  for  wantonness  and 
some  for  health's  sake ;  and  that  '  with  insatia- 
ble desire  and  greediness,  they  sucked  the  stink- 
ing smoke  thereof  through  an  earthen  pipe, 
which  they  presently  blew  out  again  at  their 
nostrils  ;  —  so  that  Englishmen's  bodies  were  so 
delighted  with  this  plant,  that  they  seemed  as  it 
were  degenerated  into  barbarians.' 

Dr.  Venner,  in  a  work  entitled  Via  recta  ad 
vitam  long-am,  published  at  London  in  1638, 
gives  a  brief  summary  of  the  injuries  done  by 
tobacco.  *  It  drieth  the  brain,  dimmeth  the 
sight,  vitiateth  the  smell,  hurteth  the  stomach, 
destroyeth  the  concoction,  disturbeth  the  humors 
and  spirits,  corrupteth  the  breath,  induceth  a 


HISTORY    AND    USE    OF    TOBACCO.  329 

trembling  of  the  limbs,  exsiccateth  the  winde 
pipe,  lungs  and  liver,  annoyeth  the  milt,  scorch- 
eth  the  heart  and  causeth  the  blood  to  be  adust- 
ed.  In  a  word,  it  overthroweth  the  spirits, 
perverteth  the  understanding,  and  confoundeth 
the  senses  with  sudden  astonishment  and  stu- 
piditie  of  the  whole  body.' 

A  poetical  philippic,  called  '  Tobacco  batter- 
red,'  was  published  in  the  reign  of  King  James, 
by  Joshua  Sylvester,  in  which  he  compares  to- 
bacco to  gunpowder,  and  pipes  to  guns  ;  making 
the  mischief  of  the  two  equal.  But  the  most 
celebrated  of  all  invectives  against  tobacco  was 
the  «  Counterblast'  of  King  James  I.  That 
weak  monarch  gave  vent  to  his  prejudices 
against  this  herb  in  a  publication,  in  which  he 
professes  to  disprove  all  the  alleged  grounds  for 
the  toleration  of  tobacco,  and  warns  his  subjects 
in  a  most  earnest  manner  not  to  sin  against 
God,  and  harm  their  own  persons  and  goods, 
and  render  themselves  scorned  and  contemned 
by  strangers,  who  should  come  among  them ; 
by  persevering  in  a  custom  loathsome  to  the 
eye,  hateful  to  the  nose,  and  baneful  to  the 
brain.' 


330  HISTORY    AND    USE    OF    TOBACCO. 

Such  were  the  commotions  excited  by  the 
introduction  and  spreading  of  an  article,  the  use 
of  which  has  now  become  so  common  as  scarce- 
ly to  attract  notice.  This  article  is  the  product 
of  several  species  of  Nicotiana,  but  chiefly  of 
the  N.  tabacum  or  Virginian  tobacco,  and  the 
N.  rustica,  sometimes  called  English  tobacco, 
and  being  the  sort  which  Sir  Walter  Raleigh 
introduced  at  the  court  of  Queen  Elizabeth. 
Another  species,  N.  fruticosa,  is  said  to  have 
been  cultivated  in  the  East  prior  to  the  discovery 
of  America.  The  Indians  on  the  banks  of  the 
Missouri  and  Columbia  rivers  cultivate  for  use 
the  N.  quadrivalvis  of  Pursh  and  Nuttall.  It 
has  been  remarked  that  the  tobacco  of  warm 
climates  is  more  mild  in  its  flavor,  while  that 
raised  in  colder  latitudes  is  more  strong  and 
pungent.  The  Bengal  tobacco,  of  which  the 
sheroots  are  made,  is  one  of  the  most  mild  in  its 
properties.  After  this  is  the  West  India  tobac- 
co which  affords  the  Havana  cigars.  Next  is 
the  tobacco  of  our  Southern  States,  and  lastly 
the  tobacco  raised  in  the  northern  parts  of  the 
Union,  which  is  the  most  acrimonious  and  pun- 
gent of  all. 


HISTORY    AND    USE    OF    TOBACCO.  331 

Chemists  have  extracted  from  tobacco  a  color- 
less liquid  alkaloid,  which  they  have  called  Ni- 
cotine. It  is  acrid  to  the  taste  and  smell,  forms 
neutral  compounds  with  acids,  and  is  intensely 
poisonous  in  minute  quantities.  Nicotianine, 
another  product,  is  a  concrete  volatile  oil,  like 
camphor,  and  resembles  tobacco  in  its  proper- 
ties. 

Among  the  substances  used  by  Sir  Benjamin 
Brodie  in  his  experiments  on  vegetable  poisons, 
was  an  empyreumatic  oil  of  tobacco  prepared 
by  Mr.  Brande  by  distilling  the  leaves  of  tobacco 
in  a  heat  above  that  of  boiling  water.  A  quan- 
tity of  watery  fluid  came  over,  on  the  surface  of 
which  was  a  film  of  unctuous  substance,  which 
he  calls  the  empyreumatic  oil.  Mr.  Brodie 
found  that  two  drops  of  this  oil  applied  to  the 
tongue  of  a  young  cat  with  an  interval  of  fifteen 
minutes  occasioned  death.  A  single  drop  sus- 
pended in  an  ounce  of  water  and  injected  into 
the  rectum  of  a  cat,  produced  death  in  about 
five  minutes.  One  drop  suspended  in  an  ounce 
and  a  half  of  mucilage  and  thrown  into  the  rec- 
tum of  a  dog,  produced  violent  symptoms,  and 
a  repetition  of  the  experiment  killed  him. 


332  HISTORY    AND    USE    OP    TOBACCO. 

Tobacco  has  been  used  both  as  a  luxury  and 
prophylactic,  and  as  a  medicine.  In  the  former 
cases  it  has  not  been  taken  internally,  but  only 
kept  in  contact  with  absorbing  surfaces.  It  is 
well  known,  that  to  the  mouth  it  is  applied  in 
substance  and  in  smoke  ;  and  to  the  nose  in  the 
form  of  powder.  The  opinion  which  at  one 
time  prevailed  of  its  power  to  prolong  life  and 
to  secure  immunity  from  diseases  is  now  pretty 
fully  abandoned.  It  has  no  prophylactic  repu- 
tation except  as  a  preservation  for  the  teeth, 
and  in  some  degree  as  a  protection  against  the 
contagion  of  epidemics.  In  both  these  cases  it 
has  acquired  a  certain  degree  of  confidence, 
though  it  is  probably  inferior  to  many  other 
substances  for  both  these  purposes. 

As  to  its  effects  upon  longevity,  the  great 
frequency  of  its  use,  and  the  facts  and  observa- 
tions of  Sir  John  Sinclair,  render  it  improbable 
that  when  moderately  taken,  it  has  much  influ- 
ence in  wearing  out  the  constitution,  or  abridg- 
ing the  usual  period  of  life.  But  like  all  other 
narcotics  its  excessive  use  or  abuse  must  impair 
the  health  and  engender  disease.  Of  the  differ- 
ent modes  of  using  tobacco,  it  is  probable  that 


HISTORY    AND    USE    OF    TOBACCO.  333 

smoking  is  the  most  injurious,  and  the  most 
capable  of  abuse,  since  in  this  process  the  active 
principles  of  the  tobacco  are  volatilized  with  the 
smoke,  and  are  extensively  applied  to  the  lungs 
as  well  as  the  mouth  and  nose  and  fauces. 

As  a  medicine,  this  plant  has  been  employed 
in  a  variety  of  ways  for  the  alleviation  and  cure 
of  diseases.  Externally  it  has  been  applied 
with  benefit  in  tinea  capitis  and  in  some  com- 
plaints occasioned  by  the  presence  of  insects. 
In  the  form  of  a  cataplasm  applied  to  the  pit  of 
the  stomach  it  occasions  severe  vomiting.  The 
prostration  of  strength  and  other  distressing 
symptoms  which  attend  this  application,  must 
prevent  its  general  employment.  Still  it  may  be 
remembered  as  an  auxiliary  in  some  cases  where 
other  emetics  have  failed  to  operate.  A  surgeon 
in  the  U.  S.  Army  informed  me  that  the  soldiers 
had  an  expedient  to  exempt  themselves  from 
duty,  by  wearing  a  piece  of  tobacco  under  each 
armpit,  until  the  most  alarming  symptoms  of 
real  illness  appeared  in  the  whole  system. 

Dr.  James  Currie  has  recorded  a  case  of  epi- 
lepsy cured  by  the  external  use  of  tobacco.  A 
cataplasm  was  applied  to  the  stomach  for  seve- 


334  HISTORY    AND    USE    OF    TOBACCO. 

ral  days  about  half  an  hour  before  the  expected 
return  of  the  paroxysm.  A  violent  impression 
was  produced  each  time  upon  the  system,  the 
paroxysm  prevented,  and  the  diseased  associa- 
tion apparently  broken  up.  Two  cases  of  obsti- 
nate and  dangerous  intermittent  were  intercept- 
ed in  the  same  manner  by  a  decoction  of  half  a 
drachm  of  tobacco  in  four  ounces  of  water, 
thrown  up  as  an  enema,  a  short  period  before 
the  time  of  the  expected  paroxysm. 

The  tobacco  enema  was  formerly  recommend- 
ed in  colic,  nephritic  complaints,  &c.  In  later 
years  it  has  been  extensively  employed  in  aiding 
the  reduction  of  strangulated  hernia.  But  since 
the  introduction  of  ether  and  chloroform  in  the 
treatment  of  this  disease,  the  use  of  tobacco  has 
been  little  resorted  to. 

When  the  infusion  is  not  used,  an  injection 
of  tobacco  smoke  into  the  rectum  frequently 
produces  the  same  consequences.  The  smoke 
may  be  made  to  penetrate  farther  than  any 
liquid,  and  it  is  equally  efficacious,  from  the 
activity  of  the  volatile  parts.  It  was  formerly 
much  used  in  the  restoration  of  persons  appa- 
rently dead  from  drowning,  but  of  late  years  it 


HISTORY    AND    USE    OF    TOBACCO.  335 

has  gone  more  into  disuse.  From  the  sedative 
effect  of  tobacco,  the  tendency  to  syncope  and 
the  great  prostration  of  strength  which  it  occa- 
sions in  ordinary  cases,  it  is  probable  that  its 
employment  in  cases  of  asphyxia  from  drown- 
ing, must  assist  in  extinguishing  rather  than  in 
rekindling  the  spark  of  life. 

Tobacco  has  been  employed  with  some  suc- 
cess in  the  locked  jaw,  both  of  warm  and  cold 
climates,  by  enemas  of  the  infusion  and  of  the 
smoke.  These  applications  generally  produce 
syncope  and  deathlike  sickness  in  the  patient, 
but  by  prudent  management  of  them,  the  dis- 
ease has  sometimes  been  overcome. 

This  powerful  medicine  is  reported  to  have 
been  also  employed  with  some  palliative  effect 
in  hydrophobia  and  certain  other  spasmodic  dis- 
eases. Its  internal  use  however  requires  great 
caution,  since  patients  have  in  various  instances 
been  destroyed  by  improper  quantities  adminis- 
tered by  the  hands  of  the  unskilful  or  unwary. 
Notwithstanding  the  common  use  and  extensive 
consumption  of  tobacco  in  its  various  forms,  it 
must  unquestionably  be  ranked  among  narcotic 
poisons  of  the  most  active  class.  The  great 


336  HISTORY    AND    USE    OF    TOBACCO. 

prostration  of  strength,  excessive  giddiness, 
fainting,  and  violent  affections  of  the  alimentary 
canal,  which  often  attend  its  internal  use,  make 
it  proper  that  so  potent  a  drug  should  be  resort- 
ed to  by  medical  men,  only  in  restricted  doses 
and  on  occasions  of  magnitude* 


EARLY  HISTORY  OF  MEDICINE. 

FROM  A  REVIEW  OF  MILLER'S  DISQUISITIONS  ON  THE  HISTORY  OP 
MEDICINE,  PUBLISHED  IN  THE  NEW  ENGLAND  JOURNAL  OF 
MEDICINE  AND  SCRGERT,  APRIL,  1812. 

IT  is  commonly  understood  that  the  history 
of  medicine  has  already  been  traced  with  suffi- 
cient accuracy  in  all  ages  and  countries,  where 
authorities  for  its  elucidation  are  extant.  The 
labors  of  Le  Clerc,  Friend,  Haller,  and  Cabanis, 
seem  to  have  left  very  little  to  be  wished  in  this 
department  of  science.  But,  although  a  general 
history  of  medicine  is  by  no  means  a  desidera- 
tum at  the  present  day,  yet  there  are  undoubt- 
edly parts  of  it  which  are  still  susceptible  of 
correction  or  enlargement.  Dr.  Edward  Miller, 
the  author  of  the  present  disquisitions,  appris- 
es us  that  he  has  been  induced  to  attempt 


338 


ON    THE    EARLY 


them,  partly  from  some  singular  traits  which  he 
thought  he  had  discovered  in  the  medicine  of 
the  early  Greeks,  and  partly  from  the  extraor- 
dinary advancement  made  of  late  years  in 
Sanscrit  literature.  By  means  of  this  last  we 
are  informed  that,  long  previous  to  its  intro- 
duction into  Europe,  the  science  of  healing  had 
made  very  considerable  progress  in  Hindostan  ; 
yet  to  commemorate  its  details,  or  appreciate 
its  merits,  has  never  yet  been  the  task  of  any 
historian  in  medicine.  This  new  field  of  re- 
search Professor  Miller  has  attempted  to  culti- 
vate, and  the  fruits  of  his  oriental  inquiries  are 
to  constitute  a  second  volume  of  Disquisitions. 
In  the  mean  time,  the  present  volume,  contain- 
ing general  archaeological  remarks,  with  specu- 
lations on  the  primitive  physic  of  Greece  and 
Egypt,  is  submitted  to  the  ordeal  of  the  public. 
It  must  be  exceedingly  obvious  that,  prior  to 
the  introduction  of  letters,  no  very  definite  in- 
formation can  be  expected  with  regard  to  the 
state  of  medical  practice  in  any  country.  If 
the  traditionary  account  of  the  most  important 
and  notorious  events,  such  as  battles  and  sieges, 
the  rise  and  fall  of  heroes  and  of  empires,  is 


HISTORY    OF    MEDICINE.  339 

involved  in  necessary  uncertainty ;  we  cannot 
expect  that  a  complex  science,  closely  inter- 
woven in  early  ages  with  mystery  and  super- 
stition, should  reach  us  in  a  state  capable  of 
affording  much  satisfaction.  The  few  tradi- 
tions handed  down  to  us  from  the  primitive 
ages,  afford  matter  for  speculation  to  the  cu- 
rious, but  yield  no  certainty  to  the  accurate. 

Dr.  Miller,  seemingly  aware  of  the  difficul- 
ties attendant  on  this  part  of  his  subject,  has 
thought  proper  to  commence  the  present  un- 
dertaking with  a  sort  of  history  a  priori,  or 
presumptive  history,  of  medicine  in  its  primaeval 
state.  He  begins  with  stating  the  progress  of 
observation  and  reasoning,  which  would  natu- 
rally be  made  by  the  early  and  rude  nations,  in 
regard  to  the  phenomena  of  life,  health,  disease 
and  death.  He  details  the  manner  in  which  a 
gradual  acquaintance  would  be  formed  with 
the  nutritious,  medical  and  deleterious  effects  of 
the  various  productions  of  nature ;  and  from 
hence  assigns  to  the  Materia  Medica  the  su- 
preme honors  of  antiquity.  Afterwards  comes 
the  knowledge  of  practical  physic,  of  anatomy 
and  of  surgery,  in  proportion  as  men  became 


340 


ON    THE    EARLY 


habituated  to  watch  the  progress  and  cure  of 
diseases,  to  butcher  and  dissect  brute  animals, 
to  sacrifice,  eat,  or  embalm  their  own  species, 
and  to  inflict  or  remedy  the  wounds  and  inju- 
ries occasioned  in  war  or  elsewhere. 

After  this  we  are  presented  with  an  interest- 
ing account  of  that  tract  of  territory,  which  we 
have  reason  to  believe  contained  the  earliest 
tribes  of  our  species.  To  this  region,  composed 
chiefly  of  Egypt,  Ethiopia,  Turkey,  Arabia, 
Persia,  and  India,  Dr.  M.  gives  the  collective 
name  of  the  Primceval  Chersonese*  He  expa- 
tiates on  the  exuberance  of  its  soil,  the  variety 
and  value  of  its  productions,  its  inducements 
for  agriculture,  and  facilities  for  commercial 
intercourse.  He  represents  that  six  races  or 
stems  have,  from  time  immemorial,  occupied 
this  ample  and  favored  portion  of  the  earth's 
surface.  These  are  the  Chinese,  the  Hindus, 
the  Tartars,  the  Iranians,  (or  Assyrians,)  the 
Arabs,  and  lastly  the  Nilotic  tribes,  or  those  of 
Egypt  and  Ethiopia.  Among  these  he  assigns 


*  '  This  application  of  the  term  Chersonese,  we  think,  rather 
stretches  its  ancient  signification. 


HISTORY    OF    MEDICINE.  341 

an  undoubted  claim  for  priority  of  civilization 
to  three  nations,  the  Hindus,  the  Iranians,  and 
the  tribes  inhabiting  the  banks  of  the  Nile. 
The  individual  claims  of  these  three  he  com- 
promises by  endeavoring  to  prove,  from  tradi- 
tion and  history,  from  identity  of  language,  &c., 
from  conformity  of  religious  and  philosophical 
opinions,  and,  lastly,  from  similitude  of  corpo- 
real structure ;  that  they  were  only  separate 
branches  of  one  and  the  same  individual  family 
or  race  of  men.  In  this  investigation  the  au- 
thor gives  proofs  of  extensive  and  assiduous 
research. 

Before  quitting  the  general  subject  of  the 
Primaeval  Chersonese,  we  are  made  minutely 
acquainted  with  its  natural  productions,  or 
those  articles  which  must  have  constituted  the 
earliest  food  and  medicine  of  man. 

We  now  come  to  the  particular  history  of 
medicine  in  early  Greece,  as  it  existed  during 
the  traditionary  ages.  On  collecting  the  scat- 
tered rays  of  information  respecting  this  period, 
chiefly  from  the  poets,  our  author  alights  on  a 
curious  circumstance,  which  he  makes  the  basis 
of  this  chapter,  viz.,  "  That,  for  its  first  discove- 


342  ON    THE    EARLY 

ries  and  improvements,  medicine  in  Greece 
appears  indebted  almost  wholly  to  two  orders 
of  men,  from  whom  such  benefit  was  not  likely 
to  be  derived,  viz. : 

'  1.  The  chiefs  or  sovereigns  of  its  different 
small  communities. 

'2.  The  priests  or  ministers  of  religion.' 

Upon  this  ground  the  author  proceeds  to 
give  us  two  dissertations  on  the  heroic  and 
the  priestly  medicine  of  Greece;  —  and  first,  of 
'heroic  medicine.' 

On  this  subject  we  are  told  that  scarcely  a 
royal  or  distinguished  personage,  during  the 
traditionary  period,  can  be  named,  to  whom 
some  degree  of  medical  skill  has  not  been  ac- 
corded. The  ascription  of  this  honor  is  traced 
to  several  causes,  such  as  the  obscurity  which 
hangs  over  the  beginning  of  all  arts ;  the  vene- 
ration which  savage  tribes  entertain  for  the 
character  of  their  leaders ;  and  the  policy  which 
would  lead  these  chiefs  to  maintain  their  as- 
cendency, by  the  display  of  every  species  of 
personal  merit  or  skill,  that  of  medicine  being 
not  the  least  imposing.  The  practice  of  these 
heroic  physicians,  which  the  author  believes  to 


HISTORY    OF    MEDICINE.  343 

have  been  chiefly  surgical,  is  illustrated  by 
various  accounts  of  the  therapeutic  exploits 
performed  by  several  individuals.  These  are 
Chiron,  Esculapius,  Machaon,  Podalirius,  Achil- 
les, Teucer,  &c.  &c.  &c.  The  claims  for  medi- 
cal distinction  are,  indeed,  so  numerous  that 
they  may  be  said  to  amount  to  no  distinction 
at  all,  since  every  man  whose  name  has  been 
handed  down  to  us  as  holding  a  rank  in  a 
tolerable  degree  above  the  vulgar,  would  seem 
entitled  to  enrolment  among  the  faculty.  Chi- 
ron the  Centaur  is  stated  to  have  been  precep- 
tor to  nearly  all  the  heroes  who  figured  in  the 
Argonautic  and  Trojan  expeditions.  Now  as 
Chiron  was  one  of  those  universal  geniuses, 
who  was  competent  to  exercise  the  arduous 
and  multiform  functions  of  warrior  and  necro- 
mancer, of  horse-breaker,  musician,  and  doctor, 
it  must  be  supposed  that  those  who  received 
the  supreme  honors  of  his  school,  were  not 
ushered  into  the  world  without  a  smattering 
of  these  various  accomplishments.  Hence  the 
crew  of  the  Argo  might,  on  emergency,  be  con- 
sidered a  crew  of  the  faculty ;  and  the  council 
of  warriors  in  Agamemnon's  camp  required 


344  ON    THE    EARLY 

only  a  change  of  occasion  to  resolve  them  into 
a  jury  of  doctors. 

We  have  already  intimated  that  any  accounts 
now  extant,  respecting  the  medicine  of  the  early 
Greeks  must  be  extremely  unsatisfactory.  We 
may  now  add,  that,  from  the  few  authorities 
we  have,  it  may  be  doubted  whether  any  pro- 
ficiency in  medicine  was  ever  made  among 
them,  beyond  what  a  rude  individual  would 
naturally  attain  in  the  science  of  self-preserva- 
tion. The  boasted  achievements  performed  by 
their  distinguished  personages  apparently  con- 
sisted in  some  trifling  and  obvious  operations, 
or  else  in  such  exaggerated  and  miraculous 
performances,  as  distance  all  possibility  of  be- 
lief. The  heroic  or  surgical  practice  among 
them  was  confined  chiefly  to  the  extraction  of 
weapons  and  the  dressing  of  wounds.  The 
highest  praise  which  Homer  has  bestowed  on 
the  medical  or  surgical  profession  is  contained 
in  the  following  lines: 

'IijTQOf  yog  '«vj(g  noAltov,  'avrcc^ios  aHltav, 

'lag  T'  ixro^vtiv,  'tTri  T'  i'jTtta  yaQuaxa  naocuv. 

Which    amount    to   simply   this,  —  that   '  one 


HISTORY    OF    MEDICINE.  345 

doctor  is  worth  a  host  of  other  men,  to  cut  out 
arrows,  and  apply  mild  dressings.'  And,  in- 
deed, whenever  he  tells  us  of  such  a  man  being 
actually  engaged  in  practice,  it  is  commonly  in 
one  or  the  other  of  the  above  processes.  Now 
it  could  require  no  great  depth  of  intellect  to  dis- 
cover, that  if  a  barbed  arrow  stuck  in  the  flesh, 
it  could  most  easily  be  removed  by  excision, 
and  that  if  a  wound  became  dry  and  painful 
from  exposure  to  the  air,  it  might  be  made  more 
comfortable  by  covering  it  with  emollient  appli- 
cations. 

But,  with  such  humble  and  obvious  opera- 
tions as  these,  the  ancient  physicians  could  not 
have  sustained  their  elevated  rank  in  society, 
and  substantiated  their  claims  upon  immortal- 
ity. It  became  necessary,  in  order  to  secure 
complete  ascendency  over  the  public  mind, 
that  they  should  profess  an  intercourse  with 
the  gods,  a  knowledge  of  mysterious  charms 
and  incantations,  and  other  special  gifts  pecu- 
liar to  jugglers  in  all  nations  since  their  time. 
Very  surprising  stories  are  told  of  Melampus, 
Polyidus,  and  Chiron.  These,  however,  are 
small  when  compared  with  the  feats  of  Escu- 


346  ON    THE    EARLY 

lapius,  the  prince  of  physicians,  and  the  deified 
inventor  of  medicine.  Esculapius,  in  addition 
to  many  other  astonishing  powers,  was  gifted 
with  a  very  remarkable  faculty,  peculiar  to 
himself,  of  raising  at  pleasure  the  dead  to  life. 
Not  less  than  six  or  seven  instances  are  on 
record  of  distinguished  corpses  that  were  bene- 
fited by  the  exertion  of  this  happy  talent.  It 
is  impossible  to  say  how  far  the  bounds  of  sci- 
ence might  have  been  enlarged  by  so  mighty  a 
genius,  had  not  Pluto  taken  alarm  at  his  pro- 
gress, and  presented  a  memorial  to  Jupiter, 
humbly  showing,  that  if  a  stop  was  not  put 
to  the  career  of  this  officious  mortal,  people 
would  soon  cease  to  die,  and  hell  would  be- 
come a  desert ;  whereupon  Jupiter  interposed, 
and  killed  the  wonder-working  doctor  with  his 
thunderbolts. 

There  is  reason  to  believe,  from  what  has 
been  said,  that  the  cures  effected  by  these  medi- 
cal worthies  were  either  inconsiderable  and  real, 
or  else  preternatural  and  counterfeited.  We 
have  additional  ground  for  this  belief,  on  find- 
ing that  frequently,  when  emergencies  occurred, 
opening  a  fine  field  for  medical  practice,  the 


HISTORY    OF    MEDICINE.  347 

champions  for  physic  were  totally  idle  or  inef- 
ficient. When  a  pestilence  broke  out  among 
the  Greeks  at  the  Trojan  war,  we  find  them 
with  all  their  heroic  and  priestly  medicine,  re- 
sorting not  to  their  drugs  and  preparations,  not 
to  any  regular  system  of  practice,  but  simply 
to  superstitious  prayers,  rites  and  atonements. 
The  Argonauts,  with  Esculapius  at  their  head, 
required  the  aid  of  a  sorceress,  before  they 
could  administer  an  opiate  to  the  dragon  that 
watched  their  fleece.  Chiron  died  of  a  wound 
or  ulcer  in  the  leg,  and  Achilles  of  one  in  the 
heel.  Such  disasters  as  these  last  were  not  to 
be  expected,  after  what  Dr.  Miller  tells  us  in  his 
account  of  Chiron  :  —  'So  celebrated  was  he  in 
tradition  for  the  cure  of  ulcers,  as  we  are  in- 
formed by  Galen,  that  when  a  sore  was  obsti- 
nate and  could  not  be  healed  up,  it  was  cus- 
tomary in  later  times  to  call  it  a  Chironian 
ulcer,  intimating,  by  the  expression,  that  it  was 
an  ailment  of  such  malignity,  as  to  baffle  the 
skill  even  of  Chiron  himself.' 

Now,  we  conceive,  it  was  no  compliment  to 
the  Centaur  to  name  only  incurables  after  him. 
We  also  conceive  that,  between  Galen  and  Dr. 


348  ON    THE    EARLY 

Miller,  the  origin  of  the  term  Chironian  ulcer 
may  have  been  mistaken,  and  that  it  may  be 
derived,  not  from  the  skill  of  Chiron  in  curing 
malignant  ulcers,  but  from  the  circumstance  of 
his  having  languished  and  died  under  a  ma- 
lignant ulcer.  Galen  informs  us  on  this  subject, 
that  of  the  phagedaena,  or  eating  ulcer,  there 
were  different  species,  called  the  Chironian  and 
Telephian  :  '  Harum  species  qusedam  sunt,  quse 
Chironia  et  Telephia  dicuntur.'  In  another 
place  he  tells  us  that  the  Telephian  ulcer  was 
so  called  from  Telephus,  who  was  afflicted  with 
it.  Now  the  case  of  Chiron  was  not  dissimilar 
to  that  of  Telephus,  as  both  their  maladies  were 
occasioned  by  the  wound  of  a  spear,  only  Te- 
lephus got  well,  whereas  Chiron,  after  languish- 
ing with  his  lame  leg  for  nine  days,  either 
died,  or  was  made  into  a  constellation ;  for  all 
which  the  reader  may  consult  Ovid.  Fastorum 
V.  379-414. 

Machaon,  the  son  of  Esculapius,  when 
wounded  at  the  siege  of  Troy,  retired  with 
Nestor  to  his  tent,  where  they  took  from  the 
hands  of  a  woman  a  farrago  of  onions,  cheese, 
meal,  honey,  and  wine.  From  Pope's  transla- 


HISTORY    OP    MEDICINE.  349 

tion  of  this  account  in  the  Iliad,  which  Dr.  M. 
has  quoted,  we  are  led  to  suppose  that  this 
potion  was  a  prescription  of  the  physician  him- 
self for  his  own  case.  Witness  the  following 
lines : 

'  The  draught  prescribed  fair  Hecamede  prepares.' 

And  again, 

'This for  the  wounded  prince  the  dame  prepares.' 

Unfortunately,  however,  there  is  no  sort  of  au- 
thority in  the  original  for  the  above  expressions, 
and  it  appears  that  Hecamede  prepared  the 
draught,  probably  of  her  own  invention,  to  treat 
her  master  Nestor,  as  well  as  his  guest  Ma- 
chaon,  and  this,  too,  for  the  sole  purpose  of 
assuaging  their  thirst. 

Toici  it  iii'x*   xvxtito  'tVTiHuxauof  'Exa/u^Sy.      II.  )..  023. 
Tio  d'  ixti  ovv  nivovt*  cufirtjv  nolvxayxia  dirfJav.*     641. 

It  is  a  little  remarkable  that  the  learned  pro- 
fessor should  copy  out  the  whole  Greek  passage 

*  The  translations  of  this  passage  by  Cowper  and  Dacier  are 
correct.     Chapman  has  the  same  inaccuracy  with  Pope. 


350  ON    THE    EARLY 

for  his  book,  and  overlook  such  words  as  rotat, 
atpwiv,  aifi  and  T<»  ;  or  imagine  them  to  be  meant 
for  Machaon  individually.  We  are  much  in- 
clined to  suspect  that  he  placed  undue  reliance 
on  the  translation,  when  we  find  him  leaving 
off  his  Greek  in  the  middle  of  a  sentence,  and 
observing  that  '  It  might  be  difficult  in  English 
poetry  to  discover  a  translation  more  distin- 
guished for  a  happy  mixture  of  precision  and 
elegance,  than  the  above  version  of  Pope.' 

One  more  of  these  worthies,  and  then  we 
have  done  with  '  heroic  medicine.'  We  pre- 
sume that  the  name  of  Achilles  will  not  yet 
descend  to  oblivion,  even  though  our  author 
should  fail  in  his  attempts  to  dub  him  also  a 
doctor  of  medicine.  Nevertheless  Achilles,  it 
seems,  was  a  pupil  of  Chiron  ;  he  cured  the 
Wound  of  Telephus  with  the  rust  of  his  spear, 
and  the  plant  Achilkea,  or  yarrow,  had  the  honor 
to  be  named  after  him.  But  it  ought  not  to  be 
forgotten,  that  the  circumstance  of  his  pupilage 
was  common  to  most  of  the  pre-eminent  heroes 
of  his  time,  and  that  in  the  cure  of  Telephus  he 
had  scarcely  any  merit.  Telephus  cousulted  the 
oracle,  and  was  told  that  his  wound  could  only 


HISTORY    OF    MEDICINE.  351 

be  healed  by  the  same  spear  which  had  occa- 
sioned it.  Accordingly  he  applied  to  Achilles, 
whose  spear  had  done  the  mischief,  and  re- 
quested his  medical  assistance.  Achilles  at  first 
refused,  saying  that  he  was  no  physician,  but 
afterwards  was  prevailed  on  to  scrape  the  rust 
of  his  spear  into  the  wound,  which  in  due  time 
got  well.  With  regard  to  the  plant  Achillsea, 
we  presume  its  name  has  as  much  to  do  with 
medicine,  as  that  of  the  plant  JefFersonia. 

We  now  come  to  consider  the  second  depart- 
ment which  Dr.  Miller  has  made  in  the  physic 
of  Greece,  viz.  his  Priestly  medicine.  As  he 
has  shown  that  the  medicine  of  heroes  was 
chiefly  surgical,  he  now  makes  it  equally  clear 
that  that  of  priests  and  conjurors  was  mere 
'  practical  physic.'  For  this  he  gives  us  all  the 
presumptive  evidence  which  can  arise  from  the 
natural  ascendency  of  priests  and  wizards  over 
the  public  mind,  and  from  the  analogy  of  cus- 
toms in  all  the  barbarous  nations  in  the  world. 
He  gives  us,  however,  only  two  instances  of 
priest-physicians  in  Greece,  viz.  Melampus  and 
Orpheus  ;  of  whom  Melampus  appears  to  us  to 
have  been  only  a  fortune-hunter,  who  cured  the 


352 


ON    THE    EARLY 


daughters  of  Proetus,  of  real  or  pretended  mad- 
ness, that  he  might  gain  the  hand  of  one  of  his 
patients,  together  with  her  kingdom,  in  mar- 
riage ;  while  with  regard  to  Orpheus,  there  is 
very  little  authority  for  his  having  practised 
physic  in  any  particular  instance,  and  his  high 
reputation  is  sufficiently  supported  by  the  es- 
tablished fact,  that 

•  He  played  so  well,  he  moved  Old  Nick.' 

On  considerations  like  the  foregoing  we  are 
disposed  to  ascribe  to  the  ancient  Greeks  the 
credit  of  very  little  real  proficiency  in  the  art 
of  healing.  From  similar  motives  we  doubt 
the  correctness  of  Dr.  Miller's  belief,  that  Greece 
was  indebted  for  its  first  discoveries  and  im- 
provements in  medicine  solely  to  two  classes  of 
men,  viz.  the  chiefs  or  sovereigns,  and  the  priests 
or  ministers  of  religion.  Unwilling,  however, 
to  interfere  with  the  doctor's  ardor  for  classifi- 
cation, we  only  suggest,  for  a  second  edition  of 
his  work,  the  propriety  of  adding  a  new  class  or 
department  in  primitive  physic,  to  be  called  the 
department  of  old  women,  or  of  female  medicine. 


HISTORY    OP    MEDICINE.  353 

These  early  practitioners  of  physic  we  think  he 
has  treated  with  unmerited  neglect,  for  we  will 
engage,  where  he  produces  one  instance  in 
Greece  of  a  priest  skilled  in  medicine,  that  we 
will  furnish  two  of  females  possessing  the  same 
accomplishment.  It  is  sufficient  now  to  men- 
tion only  the  names  of  Circe,  Medea,  Angitia, 
Agamede,  Helen  and  Oenone** 

The  last  portion  of  our  author's  work  em- 
braces the  history  of  medicine  in  Egypt  and 
the  East;  and  on  this  subject  our  limits  com- 
pel us  to  be  more  brief.  The  advantages  pos- 
sessed by  the  Eastern  countries  over  European 
Greece  for  the  early  cultivation  of  science,  are 
said  to  have  been  the  coalition  of  their  inhabi- 
tants into  large  and  mighty  empires,  instead 
of  petty  states  and  communities ;  and  also  the 
peculiar  nature  of  their  ecclesiastical  institu- 
tions, in  which  an  hereditary  priesthood  was 
placed  in  possession  of  all  the  facilities  and 

*  '  In  these  early  ages  all  the  knowledge  of  the  tribe  formed  a 
common  stock  j'and  their  imperfect  arts  might  be  exercised  by 
all  those  who  were  endowed  with  a  certain  portion  of  intelligence 
Medicine  therefore  existed  before  there  were  any  regular  physi- 
cians.' —  Cabanis's  Revolutions  of  Med.  Science. 
23 


354 


ON    THE    EARLY 


inducements  for  scientific  speculation.  The 
invention  of  letters,  or  alphabetic  characters, 
was  among  them  an  early  auxiliary  to  the 
cultivation  of  the  sciences,  and  medicine  was 
not  the  last  to  profit  by  so  signal  an  advantage. 
Some  of  the  earliest  lettered  productions  con- 
tained copious  treatises  on  the  healing  art  as  an 
integrant  portion  of  their  contents. 

The  very  ancient  and  celebrated  personage 
Thoth,  or,  as  he  is  called  by  Dr.  Miller,  Tot,  and 
who  is  the  same  with  Hermes,  or  Mercury  of 
the  Greeks,  seems  to  have  been  the  founder  of 
medicine  in  Egypt.  His  writings,  afterwards 
held  sacred,  were  divided  into  forty-two  books, 
six  of  which  treated  of  medical  subjects,  viz. 
one  of  anatomy,  one  of  diseases,  one  of  instru- 
ments, one  of  medicaments,  one  of  disorders  of 
the  eyes,  and  one  of  diseases  of  women.  While 
the  higher  orders  of  Egyptian  priesthood  were 
employed  in  the  study  and  execution  of  relig- 
ious and  philosophical  offices  contained  in  the 
former  books,  a  second  or  inferior  class  were 
busied  in  the  study  and  practice  of  healing. 
The  Pastophori,  for  so  the  cultivators  of  physic 
were  called,  were  bound  to  make  themselves 


HISTORY    OF    MEDICINE.  355 

intimately  acquainted  with  the  medical  scrip- 
tures of  Thoth,  and  so  long  as  their  practice 
was  strictly  conformable  to  these,  no  blame  was 
incurred  by  them.  On  the  contrary,  if  any 
practitioner  ventured  to  deviate  in  the  least 
from  these  sacred  rules,  he  became  responsible 
with  his  own  life  for  the  safety  of  his  patient. 
This  circumstance  must  have  furnished  a  pow- 
erful check  to  improvement,  and  kept  the  sci- 
ence of  medicine  long  in  a  state  altogether 
stationary. 

Of  the  other  peculiarities  in  Egyptian  prac- 
tice, the  following  are  among  the  most  remark- 
able. The  art  was  made  altogether  hereditary, 
so  that  '  he  who  was  born  a  physician  was  pro- 
hibited equally  by  Heaven  and  by  law  from 
abandoning  the  occupation  of  his  ancestors.' 
The  profession  was  also  subdivided  into  minute 
departments,  so  that  each  particular  disease  had 
a  separate  healer.  Some  took  charge  of  disor- 
ders of  the  eyes,  some  of  the  head,  some  of 
the  teeth,  some  of  the  abdomen,  &c.  The 
vast  number  of  individuals  who  were  engag- 
ed in  some  branch  of  medical  practice,  led 
to  the  assertion  of  Homer  and  Herodotus, 


356  ON    THE    EARLY 

that  in  Egypt  every  man  met  with  was  a 
physician. 

What  were  the  particular  modes  of  practice 
enjoined  by  Thoth  it  is  impossible  now  to 
know,  for  the  books  of  the  Pastophori  have 
long  since  been  lost.  Dr.  Miller,  however,  has 
industriously  attempted  to  glean  whatever  au- 
thorities were  afforded  respecting  them,  from 
their  successors  in  art  and  science,  the  Greeks. 
He  has  told  us  that  the  Pastophori,  and  even 
the  kings,  were  wont  to  immolate  and  dissect 
beasts  and  human  victims,  but  with  what  pro- 
ficiency in  anatomy  it  is  not  known.  In  the 
science  of  diseases  they  appear  to  have  had 
some  idea  of  critical  days,  to  have  divided 
disorders  into  acute  and  chronic,  and  to  have 
ascribed  their  pestilential  distempers  to  a  mor- 
bific principle  in  the  air.  In  the  Materia  Medi- 
ca  they  seem  to  have  been  acquainted  with 
many  efficacious  articles,  together  with  their 
most  useful  forms  of  composition. 

Having  now  run  through  the  contents  of  this 
volume,  we  would  observe  that,  in  general,  it 
is  far  from  being  an  uninteresting  production. 
The  extent  of  the  author's  researches,  and  the 


HISTORY    OF    MEDICINE.  357 

ingenuity  of  his  deductions,  will  afford  some 
novelty  and  instruction  to  most  readers.  His 
predominant  fault  is  a  disposition  to  annex  an 
undue  consequence  to  circumstances  which  are 
doubtful  or  unimportant.  We  think  he  might 
profit  by  the  observation  of  Cabanis,  that  in  a 
subject  where  materials  to  compensate  inquiry 
are  wanting,  '  the  friends  of  truth  should  not 
lose  their  time  in  forming  vain  conjectures, 
however  learned  they  may  happen  to  be.5 


ADDRESS 

DELIVERED   BEFORE 

THE  AMERICAN  ACADEMY  OF  ARTS  AND  SCIENCES, 

AT  THE   OPENING   OF  THEIR  COUESE   OF  LECTUBES, 
OCTOBEB  27,    1852. 


AT  a  meeting  of  the  American  Academy  of  Arts  and  Sciences, 
June  22,  1852,— 

Mr.  Agassiz,  in  behalf  of  the  committee  appointed  to  consider 
the  best  means  of  increasing  the  Academy's  publication  fund, 
reported,  —  that  the  committee  were  unanimous  in  recommend- 
ing that  a  course  of  public  lectures  of  a  popular  character  be 
given  by  Fellows  of  the  Academy  during  the  ensuing  winter  ; 
that  the  President  be  requested  to  commence  the  course  by  an 
Address  setting  forth  the  objects  and  aim  of  the  course  ;  and 
that  each  section  of  the  Academy  appoint  one  of  its  number  to 
deliver  one  lecture  upon  some  special  subject  belonging  to,  and 
prominent  in,  the  section's  sphere  of  research. 

IT  has  been  a  serious  question  whether  amid 
the  general  sadness  which  hangs  as  a  cloud  over 


ACADEMY    OP    ARTS    AND    SCIENCES.          359 

our  city,  which  has  seemed  to  check  the  ordinary 
current  of  affairs,  and  to  darken  the  very  atmos- 
phere of  social  intercourse,*  the  pre-arranged 
exercises  of  this  place  should  not  be  suspended 
in  solemn  and  silent  respect  to  the  unusual  oc- 
casion. But  we  are  bound  by  circumstances  to 
perform  that  which  at  this  time  we  would  not 
have  wished  to  do.  And  leaving  to  the  public 
voice  the  expression  of  that  general  emotion,  to 
which  no  limited  occasion  can  afford  utterance, 
we  shall  proceed  in  the  attempt  to  execute  the 
more  humble  duty  that  has  been  set  before  us. 
I  am  instructed  in  behalf  of  the  American 
Academy  of  Arts  and  Sciences  to  report  to  you 
this  evening  on  the  character  and  condition  of 
that  institution,  and  the  objects  of  the  present 
course  of  lectures.  If  it  were  possible  that  a 
Society  which  has  existed  in  your  midst  for  two 
or  three  generations,  and  which  from  time  to 
time  has  numbered  among  its  members  many 
of  the  most  enlightened  and  valuable  of  our  cit- 
izens, could  be  in  any  measure  unknown,  I 
might  safely  rely  on  the  more  gifted  laborers 
who  are  to  follow  me  in  this  field,  for  the  vindi- 

*  The  death  of  Daniel  Webster. 


360  ADDRESS    BEFORE    THE    AMERICAN 

cation  of  its  character  and  name.  And  if  the 
present  occupation  of  this  lecture  room  were  a 
question  of  doubtful  propriety,  I  might  briefly 
say  that  the  Academy  needs,  nay,  more,  that  it 
deserves  your  countenance  and  support,  and  that 
this  is  the  place  and  the  manner  in  which  your 
kind  regards  have  been  solicited  towards  the 
encouragement  of  its  labors.  But  as  the  quiet 
operations  of  Science  have  not  the  wide-spread 
notoriety  which  attends  the  more  absorbing 
questions  of  peace  and  war,  of  property  and 
'privilege,  of  safety  and  of  danger,  there  is  reason 
for  attempting  a  more  detailed  consideration  of 
the  objects  and  results  of  our  Academic  Incor- 
poration. 

Academies  in  the  higher  use  of  the  term,  phi- 
losophical and  learned  societies,  exist  and  have 
long  existed  in  every  country  of  civilized  Eu- 
rope. In  common  with  Colleges  and  Universi- 
ties they  are  designed  to  cultivate  and  dissemi- 
nate scientific  truth,  but  unlike  those  institutions, 
the  usual  province  of  the  modern  Academy  is  to 
investigate  rather  than  to  teach,  to  bring  together 
experts  from  the  various  walks  of  science,  litera- 
ture and  art,  to  accumulate  for  the  benefit  of  the 


ACADEMY    OP    ARTS    AND    SCIENCES.          361 

whole  the  researches  and  observations  of  all,  to 
aid  and  to  encourage  the  different  inquirers  on 
their  respective  tracks,  and  to  furnish  vehicles  for 
what  is  true,  and  ordeals  for  what  is  unsettled, 
in  the  progress  of  human  knowledge. 

One  of  the  early  fruits  of  the  restoration  of 
arts  and  letters  in  Italy  was  the  perception  of 
the  great  advantage  attending  the  combination 
of  effort  in  Academic  institutions.  In  that 
country  were  the  first  efficient  examples  of 
learned  bodies  cooperating  for  their  common 
good,  and  bringing  their  united  efforts  to  bear  in 
the  promotion  of  the  arts  and  sciences.  From 
Italy  the  principle  of  Academic  association 
spead  to  England,  Germany,  and  France,  and 
in  all  those  countries,  noble  institutions,  having 
their  foundation  in  the  earnest  quest  of  truth, 
and  supported  by  the  zeal  and  learning  of  the 
best  men  of  their  times,  have  been  sent  down  to 
the  present  age,  marking  their  way  by  many 
high  developments  of  human  intellect,  and  noble 
achievements  of  human  science.  Some  of  them 
which  for  two  centuries  have  enjoyed  the  sun- 
shine of  royal  and  public  patronage,  now  find 
themselves  entrenched  in  ample  halls,  surround- 


362  ADDRESS    BEFORE    THE    AMERICAN 

ed  by  the  machinery  of  modern  science,  dispens- 
ing rewards  with  princely  prodigality,  offering 
seats  of  which  the  prospective  vacancy  fills  with 
ambition  the  learned  of  foreign  countries,  throw- 
ing lustre  on  the  cities  of  their  respective  estab- 
lishment, and  connected  by  little  resemblance, 
save  that  of  etymology,  with  the  simple  pre- 
ceding groves  of  Plato  and  Arcesilaus. 

Academic  institutions  have  differed  widely 
from  each  other  in  the  object  as  well  as  the 
comprehensiveness  of  their  pursuits.  Not  only 
does  the  history  of  literature  furnish  many  ex- 
amples of  Academies  of  Sciences  and  the  Arts, 
but  there  are  well-known  like  institutions  of 
Belles  Lettres,  of  Language,  of  Inscriptions,  of 
Painting,  Sculpture  and  Architecture,  of  Music, 
of  Antiquities,  and  of  many  subordinate  branches 
of  useful  and  of  elegant  learning.  Of  course 
the  value  of  membership  in  any  of  these  bodies 
has  depended  on  the  character  of  the  institution 
itself,  and  the  principles  on  which  it  is  conduct- 
ed. The  Royal  Academy  of  France,  often 
known  par  excellence  as  the  Academy,  not  only 
under  its  original  name,  but  under  the  subse- 
quent appellations  of  National  and  Imperial 


ACADEMY    OF    ARTS    AND    SCIENCES.          363 

Institute,  has  during  a  long  period  of  years,  sus- 
tained an  almost  uninterrupted  preeminence  in 
the  republic  of  letters.  The  labors  of  this  body 
have  cast  a  flood  of  light  on  modern  science, 
and  its  assembled  savans  have  formed  a  tribunal 
from  whose  scientific  sentence  there  seemed  no 
appeal.  Yet  even  this  institution,  under  the 
occasional  supineness  of  its' members,  and  the 
influence  of  royal  favoritism,  has  more  than 
once  been  a  mark  for  the  shafts  of  cotempora- 
neous  criticism.  The  poet  Piron,  affecting  to 
define  his  own  humble  position  by  an  epitaph, 
says,  '  Here  lies  Piron,  who  was  nothing  at  all, 
not  even  an  Academician.' 

In  the  year  1779,  in  the  midst  of  the  exhaust- 
ing and  yet  unfinished  contest  of  our  Revolution, 
with  humble  resources,  but  with  confidence  of 
future  promise,  the  American  Academy  of  Arts 
and  Sciences  was  founded  by  an  association  of 
citizens  of  Massachusetts.  The  fathers  of  our 
Commonwealth,  well  aware  that  the  lights  of 
liberty  and  learning  are  jointly  conducive  to  the 
stability  of  free  government,  gave  their  sanction 
and  in  many  cases  their  individual  efforts  to 
construct  the  foundation  of  an  ample  edifice. 


364  ADDRESS    BEFORE    THE    AMERICAN 

Among  the  constellation  of  worthies  enrolled  as 
its  first  members,  we  find  the  names  of  the  two 
Adamses,  of  Bowdoin  and  Gushing,  of  Chaun- 
cey  and  Cooper,  of  Hancock,  of  Lowell,  of  Sedg- 
wick,  Strong  and  Sullivan,  and  about  fifty 
others,  all  of  them  names  already  registered  in 
the  annals  of  their  country's  service,  or  distin- 
guished as  proficients  in  the  learning  of  their 
time. 

The  preface  to  their  first  publication  states 
that  the  Legislature  was  called  on  to  sanction 
the  society  on  a  liberal  and  extensive  plan,  and 
to  establish  it  on  a  firm  basis.  '  And  to  the 
honor  of  our  political  fathers,'  say  they,  «  be  it 
spoken,  that  although  the  country  was  engaged 
in  a  distressing  war,  a  war  the  most  important 
to  the  liberties  of  mankind  that  was  ever  under- 
taken by  any  people,  and  which  required  the 
utmost  attention  of  those  who  were  entrusted 
with  our  public  concerns,  they  immediately  ad- 
verted to  the  usefulness  of  the  design,  entered 
into  its  spirit,  and  incorporated  a  society  with 
ample  privileges.' 

But  the  approval  of  the  Legislature  was  but 
a  small  offset  to  the  difficulties  against  which 


ACADEMY    OF    ARTS    AND    SCIENCES.          365 

the  new  association  had  to  contend.  '  The 
country  being  young,'  say  they,  '  few  among  us 
have  such  affluence  and  leisure  as  to  admit  of' 
our  '  applying  much  time  to  the  cultivation  of 
the  sciences.'  And  in  another  place,  '  many  im- 
portant European  discoveries  have  been  in.  a 
great  measure  useless  to  this  part  of  the  world, 
in  consequence  of  a  situation  so  remote  from 
the  ancient  seats  of  learning  and  improvement. 
And  of  such  publications  as  have  reached  this 
country,  the  smallness  of  the  number  has  greatly 
limited  their  usefulness,  as  but  few  have  had  the 
opportunity  for  perusing  them.' 

Under  such  disadvantages,  so  unlike  the  state 
of  things  now,  well  might  our  courageous  pred- 
ecessors solace  and  assure  themselves  by  a  pro- 
spective view  of  the  harvests  they  were  sowing 
for  their  descendants.  '  Settled,'  say  they,  '  in 
an  extensive  country,  bordering  upon  the  ocean, 
and  open  to  a  free  intercourse  with  all  the 
commercial  world,  —  a  country  comprehending 
several  climates  and  a  rich  variety  of  soils, 
watered  and  fertilized  by  multitudes  of  springs 
and  streams,  and  by  many  grand  rivers,  —  the 
citizens  have  great  opportunities  and  advan- 


366     ADDRESS  BEFORE  THE  AMERICAN 

tages  for  making  useful  experiments  and  im- 
provements whereby  the  interests  and  happiness 
-of  the  rising  empire  may  be  essentially  advanced. 
At  the  same  time  enjoying,  under  a  mild  but 
steady  government,  that  freedom  which  excites 
and  rewards  industry  and  gives  a  relish  to  life, 
—  that  freedom  which  is  propitious  to  the  diffu- 
sion of  knowledge,  which  expands  the  mind  and 
•engages  it  to  noble  and  generous  pursuits, — 
they  have  a  stimulus  to  enterprise  which  the 
inhabitants  of  few  other  countries  can  feel.' 

Such  were  the  principles  and  the  auspices 
under  which  was  kindled  the  small  dim  light  of 
•our  Academy.  Although  it  was  not  often  over- 
fed with  fuel,  nor  at  all  times  watched  with 
vestal  vigilance,  it  has  at  least  never  been  suf- 
fered to  go  wholly  out,  and,  after  glimmering 
with  uncertain  yet  increasing  rays  for  two-thirds 
of  a  century,  it  has  at  length  grown  to  be  an 
acknowledged  beacon  in  science,  a  light  to 
the  philosophic  of  our  own  country,  a  western 
star  to  whose  unshadowed  brilliancy  and  true 
monitions  the  European  world  now  looks  with 
interest  and  respect. 

The  early  labors  of  the  Academy  were  in 


ACADEMY    OF    ARTS    AND    SCIENCES.  367 

keeping  with  its  early  professions.  They  did 
not  trench  deeply  on  fields  appropriated  by  for- 
eign explorers,  but  rather  turned  their  inquiries 
to  the  capacities  of  their  own  country,  to  the 
improvement  of  its  practical  advantages  and  the 
knowledge  of  its  natural  history.  With  the 
exception  of  a  few  limited  papers  in  mathe- 
matics and  astronomy,  the  first  volumes  of  the 
Transactions  are  occupied  with  such  objects  as 
the  cultivation  of  corn  and  the  engrafting  of 
trees,  examination  of  springs  of  water,  and 
reports  on  diseases  of  cattle,  speculations  on 
natural  caves,  recorded  earthquakes  and  conjec- 
tured volcanoes.  Narratives  are  given  of  the 
appearance  of  water-spouts,  and  of  remarkable 
devastations  of  lightning  on  trees,  rocks  and 
dwelling-houses.  Fossil  frogs,  'that  under  the 
cold  stone'  were  believed  to  have  passed  monot- 
onous ages  of  incomprehensible  existence,  are 
presented  in  these  memoirs,  living  and  jumping 
before  the  reader.  Flocks  of  swallows,  black- 
ening the  air  with  their  numbers,  abandon  the 
joyous,  twittering,  feather-chasing  career  of 
their  summer  life,  and  with  ominous  solemnity 
assemble  on  the  banks  of  some  stagnant  pool, 


368  ADDRESS    BEFORE    THE    AMERICAN 

rendered  famous  perhaps  with  the  tradition  of 
former  engulphments  of  their  species,  and  then 
—  are  seen  no  more.  A  cloud  settles  on  the 
mystery  of  their  wintry  existence,  and  the  won- 
der was  that  when  they  appeared  in  the  follow- 
ing spring,  their  sleek  and  glossy  plumage  bore 
no  traces  of  the  deep  mud  under  which  they 
were  believed  to  have  slept  out  their  hyberna- 
tion. 

The  riches  of  our  vegetable  kingdom  and  the 
importance  of  establishing  a  more  thorough  and 
practical  knowledge  of  its  different  portions,  did 
not  escape  the  attention  of  the  pioneers  of  our 
natural  history.  Great  difficulties  beset  the 
early  botanists  in  the  prosecution  of  their  inqui- 
ries, from  the  novelty  of  the  subject,  the  paucity 
of  books,  and  the  difficulty  of  maintaining  cor- 
respondence with  foreign  scientific  authorities, 
in  those  cases  where  books  are  insufficient  and 
knowledge  to  a  certain  extent  must  be  ocular 
and  traditionary.  Yet  the  Rev.  Dr.  Cutler,  of 
our  State,  has  culled  for  himself  an  enduring 
garland  from  a  field  in  which  it  would  appear 
that  the  harvest  was  plenteous,  but  the  laborers 
were  few. 


ACADEMY    OF    ARTS    AND    SCIENCES.          369 

The  valleys  of  New  England  are  not  the  seat 
of  antiquities  and  hieroglyphic  records,  yet  in* 
the  earlier  volumes  of  the  Transactions  there  is 
more  than  one  account  of  the  memorable  in- 
scription on  our  far-famed  Dighton  rock.  This 
curious  relic  of  the  scattered  and  now  fast  dis- 
appearing aboriginal  inhabitants  of  our  country, 
is  copied  and  described  by  various  persons,  and 
hypothetically  explained  by  the  late  excellent 
Judge  Davis  of  this  city.  Whatever  be  the 
mystery  it  involves,  a  hunting  scene  or  a  relig- 
ious rite,  an  achievement  of  war  or  of  conquest, 
the  pages  of  the  Academy  offer  a  faithful  fac- 
simile for  the  use  of  foreigners  and  of  posterity, 
who  may  happen  to  find  themselves  called  and 
competent  to  its  perusal. 

But  by  far  the  most  ambitious  among  the 
early  speculations  of  the  Academy,  is  the  theory 
of  Governor  Bowdoin,  then  President  of  the  In- 
stitution, on  the  existence  in  the  universe  of  an 
all-surrounding  orb.  That  distinguished  gentle- 
man and  scholar,  after  various  speculations  on 
the  supposed  waste  of  material  light  from  the 
surface  of  the  sun,  and  the  danger  to  all  mate- 
rial bodies  from  their  own  unresisted  gravity 
24 


370     ADDRESS  BEFORE  THE  AMERICAN 

attracting  them  towards  each  other,  published 
an  elaborate  memoir,  entitled  '  Observations 
tending  to  prove  by  phenomena  and  scripture, 
the  existence  of  an  orb  which  surrounds  the 
visible  material  system,  and  which  may  be 
necessary  to  preserve  it  from  the  ruin  to  which, 
without  such  a  counterbalance,  it  seems  liable, 
by  that  universal  principle  in  matter,  gravita- 
tion.' 

The  author  satisfies  himself  by  a  train  of 
ingenious  reasoning,  of  the  sufficiency  of  his 
theory  to  prevent  the  apprehended  catastrophe. 
He  deals  not  only  with  the  necessities  of  such 
an  arrangement  to  produce  stability  in  our  uni- 
verse, but  draws  supernumerary  arguments  from 
the  presence  of  the  milky  way,  the  blue  color  of 
the  firmament,  and  lastly  from  various  corrobo- 
rative texts  of  scripture. 

History  is  silent  in  regard  to  the  extent  of  the 
impression  made  upon  the  world  by  the  promul- 
gation of  this  comprehensive  theory.  The  orb 
is  supposed  to  have  been  standing  several  years 
after  the  announcement  of  its  character  and 
office,  —  and  when  it  fell,  the  Academy,  nothing 
daunted,  proceeded  to  prosecute  its  celestial  in- 


ACADEMY    OF    ARTS    AND    SCIENCES.          371 

vestigations  with  a  zeal  and  tenacity  of  purpose 
prophetic  of  its  future  more  elevated  destiny. 

tenacem  propositi 

si  fractus  illabatur  orbis 

Impavidum  ferient  ruinae. 

Should  any  one  incline  to  disparage  the 
labors  of  our  predecessors  on  account  of  their 
honest  and  earnest,  though  sometimes  misdi- 
rected inquiries  for  truth,  he  will  find  parallel 
examples  in  the  early  history  of  every  learned 
body  in  Europe  of  a  century's  standing.  The 
first  publications  of  the  oldest  philosophical 
societies  contain  speculations  on  the  transmuting 
of  metals,  projects  for  perpetual  motion,  schemes 
for  raising  water  without  power,  and  for  flying 
in  the  air  by  machinery,  credulous  inquiries 
about  secret  poisons  and  fabulous  natural  pro- 
ductions. They  did  not  think  it  beneath  them 
to  investigate  extravagant  rumors,  and  they 
often  propounded  interrogatories  with  this  view, 
to  foreign  ambassadors,  missionaries,  merchants 
and  navigators.  The  Royal  Society  of  London 
sent  many  grave  inquiries  to  Sir  Philberto  Ver- 
natti,  then  resident  in  the  Indies,  in  hopes 
to  solve  some  of  the  difficulties  which  were 


372  ADDRESS    BEFORE    THE    AMERICAN 

weighing  upon  them.  The  first  of  these  was, 
'  Whether  diamonds  and  other  precious  stones 
grow  again  after  three  or  four  years  in  the  same 
places  where  they  have  been  digged  out.'  The 
catagorical  answer  to  this  question  is,  '  Never.' 
Another  inquiry  is,  '  Whether  in  the  island  of 
Sombrero  there  be  found  such  a  vegetable  as 
Master  James  Lancaster  relates  to  have  seen, 
which  grows  up  to  a  tree,  shrinks  down  when 
*  one  offers  to  pluck  it,  and  would  quite  shrink 
unless  held  very  hard.'  Sir  Philberto  replies, 
that  he  '  cannot  meet  with  any  that  ever  heard 
of  such  a  vegetable.' 

Again  they  inquire,  '  Whether  the  Indians 
can  so  prepare  that  stupefying  herb  Datura,  that 
they  may  make  it  lie  several  days,  months, 
years,  according  as  they  will  have  it,  in  a 
man's  body,  and  at  the  end  kill  him  without 
missing  half  an  hour's  time.' 

The  29th  question  is,  '  Whether  there  be  a 
tree  in  Mexico  that  yields  water,  wine,  vine- 
gar, oil,  milk,  honey,  wax,  thread,  and  needles.' 
The  answer  here  is  more  encouraging,  '  The 
Cocos  trees  yield  all  this,  and  more.' 

In  the  inquisitiveness  and  credulity  which 


ACADEMY    OF    ARTS    AND    SCIENCES.          373 

marked  these  early  stages  of  scientific  inquiry, 
we  have  at  least  the  gratifying  assurance,  that 
our  philosophic  fathers  did  not  close  their  ears 
against  the  reception  of  knowledge,  from  what- 
ever quarter  it  might  proceed.  They  were  just 
emerging  from  the  deep  intellectual  darkness, 
which  for  long  ages  had  brooded  over  the  world. 
They  were  the  survivors  of  many  generations, 
among  whom  to  inquire  had  been  a  crime,  to 
reason  had  been  a  heresy,  and  to  experiment  a 
satisfactory  evidence  of  intercourse  with  the 
powers  of  darkness.  Secretly,  and  by  stealth 
and  stratagem,  the  germs  of  science  had  here 
and  there  been  nourished  into  visible  life,  but 
the  air  and  the  sunlight  of  heaven  were  denied 
to  their  upward  expanding  tendencies.  And 
when  at  length,  with  the  Reformation,  the  revi- 
val of  letters  and  the  introduction  of  the  print- 
ing press,  a  veil  was  lifted  from  the  moral  and 
material  world,  no  wonder  that  inquiring  eyes 
were  dazzled  and  strong  heads  were  turned  with 
the  startling  developments  of  the  solar  system, 
the  circumnavigation  of  the  globe,  and  the  prac- 
ticable intercourse  of  men  and  nations  with  each 
other. 


374  ADDRESS    BEFORE    THE    AMERICAN 

The  comparatively  short  period  during  which 
the  American  Academy  has  existed,  has  been 
one  of  advanced  and  rapid  progress  in  the  histo- 
ry of  science  throughout  the  world.  It  has  been 
the  era  of  the  Herschels  and  Laplace,  of  Lavoi- 
sier and  of  Davy,  of  Cuvier,  of  Watt,  and  a  host 
of  gigantic  minds,  whose  conquests  over  un- 
known regions  will  never  be  obliterated  from 
the  map  of  science.  During  this  period  of  pro- 
gress, the  small  number  and  limited  opportuni- 
ties of  the  scientific  men  of  our  own  hemisphere 
have  been  such  as  to  render  them  lookers-on, 
recipients  and  dispensers,  rather  than  origina- 
tors of  new  discovery.  For  many  years  the 
publications  of  this  Academy  were  so  sparse  and 
inconsiderable  as  to  induce  serious  question  from 
some  foreign  scientific  bodies,  whether  the  usual 
exchange  of  printed  transactions  were  worth 
keeping  up.  There  was  a  long  period,  during 
which  the  late  venerated  Bowditch  seemed  to 
be  the  almost  solitary  pillar  on  whose  support 
the  Academy  relied  for  its  character  and  position 
in  the  philosophic  world.  And  to  his  praise  be 
it  said,  that  while  engaged  in  the  surpassing 
labors  which  have  constituted  the  monument 


ACADEMY    OF    ARTS    AND    SCIENCES.          375 

of  his  living  and  posthumous  fame,  he  never 
shrunk  from  identifying  his  name  with  a  small, 
and  then  almost  obscure  institution  of  his  native 
country.  Punctual  in  his  attendance  on  its 
meetings,  earnest  in  his  appeals  to  the  lag- 
ging industry  of  its  members,  foremost  in  every 
movement  for  its  prospective  welfare,  pouring 
into  its  vacant  pages  the  overflowings  of  his 
own  exuberant  mind,  he  was  not  only  a  centre, 
but  a  central  fire ;  not  only  attracting  but  excit- 
ing, warming,  illuminating  all  within  the  circle 
of  his  influence.  By  his  side  walked  the  accom- 
plished Pickering,  laborious,  erudite,  modest,  a 
votary  of  learning  for  its  own  sake,  whose  capa- 
cious and  cultivated  mind,  affluent  in  various 
lore,  seemed  poor  only  to  his  own  aspiring  and 
comprehensive  genius. 

By  these  men,  more  than  all  others,  in  the 
day  of  its  obscurity,  was  this  Academy  cherished 
and  upheld.  They  did  not  feel  authorized  to 
boast  much  of  its  history  nor  of  its  existing  per- 
formances. They  were  not  vainglorious  of  their 
own  share  in  whatever  of  reputation  it  might 
have  happened  to  acquire.  But  they  felt  and 
expressed  that  in  i,t  was  contained  the  germ  of 


476  ADDRESS    BEFORE    THE    AMERICAN 

future  development,  that  to  a  certain  extent  it 
had  books,  and  endowments,  and  position,  that 
it  was  their  duty  and  that  of  their  cotemporaries 
to  cultivate  its  capacities,  to  improve  its  con- 
dition, and  at  least  to  preserve  it  unimpaired, 
until  the  increasing  population  and  wealth  in 
our  country,  and  correspondent  increase  of  the 
men  and  means  of  science,  should  impart  to  it  a 
vigorous  vitality,  like  that  which  sustains  the 
older  institutions  of  Europe. 

We  do  not  assume  too  much  in  saying  that 
this  period  has  at  length  arrived.  The  thinly 
attended  meetings,  few  and  far  between,  in 
which  a  quorum  was  with  difficulty  convened, 
perhaps  only  to  spend  an  hour  in  debating  a 
by-law  or  electing  a  foreign  fellow,  have  been 
replaced  by  monthly  and  semi-monthly  gather- 
ings, in  which  the  time  is  often  too  short  to  give 
utterance  to  the  accumulated  researches  of  the 
members.  The  demand  for  publication  of  new 
and  important  matter  outstrips  the  limited  re- 
sources of  the  treasury,  and  now  brings  the 
institution  before  the  public  of  this  city,  a  solici- 
tor for  the  hearing  of  its  claims.  What  is  it 
that  this  Academy,  through  its  members,  is  now 


ACADEMY    OF    ARTS    AND    SCIENCES.  377 

performing  ?  What  is  it  that  it  asks  the  means 
of  publishing  to  the  world  ?  Not  the  meagre 
and  uninteresting  record  of  every-day  phenom- 
ena. Not  the  premature  speculations  of  unqual- 
ified reasoners  on  more  expanded  subjects. 
Not  the  repeated  lessons  received  with  un- 
questioning docility  from  the  higher  sources  of 
transatlantic  wisdom.  It  now  rather  sits  in 
judgment  on  unsettled  questions  of  European 
science,  and  pushes  its  own  unaided  investiga- 
tions beyond  the  previous  bounds  of  human 
knowledge.  Its  researches  during  the  last  five 
or  six  years  have  been  such  in  magnitude  and 
importance  that  they  may  without  disadvantage 
be  brought  into  comparison  with  those  of  many 
of  the  time-honored  institutions  of  the  old  world. 
Closely  connected  with  our  distinguished  Univer- 
sity, numbering  among  the  teachers  of  that  sem- 
inary a  large  portion  of  its  most  accomplished 
and  efficient  members,  making  the  pages  of  its 
publications  a  vehicle  for  the  light  which  ema- 
nates from  the  observatory,  the  apparatus,  the 
collections  of  that  venerable  seat  of  learning, 
aided  moreover  by  the  naturalists,  the  philoso- 
phers and  the  annalists  of  other  societies  among 


378  ADDRESS    BEFORE    THE    AMERICAN 

us,  it  has  established  an  influence  which  could 
not  well  be  now  spared  from  the  republic  of 
science. 

We  may  say,  without  fear  of  contradiction, 
that  there  are  few  branches  of  physical  knowl- 
edge which  have  not  been  illustrated  or  enlarged 
by  the  members  of  this  body,  and  when  difficult 
labors  are  to  be  performed,  or  difficult  problems 
to  be  solved,  no  source  of  information  in  our 
country  has  been  deemed  more  reliable,  or  more 
frequently  been  put  in  requisition,  than  the  au- 
thority of  this  Academy.  The  plants  of  Cali- 
fornia and  New  Mexico  have  repeatedly  come 
here  to  be  named  and  described.  The  late 
exploring  expedition  sent  to  this  city  a  large 
portion  of  its  collected  treasures,  for  investiga- 
tion and  judgment.  The  fossil  bones  of  gigan- 
tic quadrupeds  are  accumulated  in  our  midst 
with  a  completeness  and  abundance  such  as  is 
found  in  no  other  place  ;  and  they  are  presented 
to  the  world  with  an  amplitude  of  scientific 
delineation,  seldom,  if  ever,  surpassed.  Huge 
limbs  and  heads  of  undescribed  troglodytes, 
exceeding  those  of  man  which  they  counterfeit, 
and  whose  race  is  now  living  in  African 


ACADEMY    OF    ARTS    AND    SCIENCES.          379 

forests,  have  received  their  first  description  in 
this  city. 

The  pages  of  our  Transactions  offer  the  faith- 
ful impress,  not  elsewhere  found,  of  the  foot- 
prints of  colossal  birds  and  mysterious  reptiles, 
transferred  from  the  banks  of  our  own  rivers, 
where,  awaiting  the  perusal  of  the  naturalist, 
they  have  lain  for  unknown  ages,  stereotyped  in 
stone.  It  is  fresh  in  our  recollection,  that  when 
the  credulity  of  the  popular  voice,  not  without 
the  assent  of  men  of  science,  had  given  a  ficti- 
tious reality  to  a  monster  compounded  of  con- 
tributions levied  from  many  individuals,  and 
when  this  deception  gained  foothold  not  only  in 
our  own  greatest  city,  but  afterwards  in  one  of 
the  enlightened  capitals  of  Germany,  the  doubt 
was  removed  and  the  deception  made  man- 
ifest by  the  scientific  sentence  of  one  of  this 
Academy. 

A  few  years  ago  a  call  was  made  by  the  Le- 
gislature of  this  Commonwealth  for  researches 
into  the  various  departments  of  its  indigenous 
natural  history.  This  call  was  promptly  and 
ably  responded  to,  and  the  reports  returned  on 
the  geology,  the  forest  trees,  the  fishes,  the  in- 


380  ADDRESS    BEFORE    THE    AMERICAN 

sects,  and  the  other  invertebrata  of  Massachu- 
setts, were  in  the  highest  degree  creditable  to 
those  Academicians  from  whose  labors  they 
emanated.  Some  of  these  subjects  are  yet 
waiting  the  results  of  this  course  of  lectures,  to 
give  their  illustrations  to  the  public. 

The  incipient  mysteries  of  organic  develop- 
ment, the  structure  and  transformations  of  the 
animalcular  world,  the  scarce  visible  organisms 
which  fill  our  waters  with  busy  and  effective 
life,  the  unknown  generations  which  have  writ- 
ten with  their  own  remains  the  history  of 
preceding  nature,  have  often  been  drawn  from 
obscurity,  their  laws  and  limits  studied,  and 
many  of  their  new  and  unknown  forms  for  the 
first  time  described  and  arranged  by  one  of  our 
adopted  members,  whom  we  may  well  place  in 
the  foremost  rank  of  living  naturalists.  And  as 
if  to  indicate  the  claim  to  notice  of  what  might 
seem  a  humble  department  of  zoology,  we  have 
been  taught  from  the  same  indefatigable  source, 
that  since  the  period  of  man's  existence  on  this 
globe,  a  vast  peninsula,  constituting  nearly  an 
entire  State  of  this  Union,  has  been  raised  from 
the  bottom  of  the  ocean  and  added  to  the  previ- 


ACADEMY    OF    ARTS    AND    SCIENCES.         381 

ous  continent  by  the  silent  conspiring  agency  of 
coral  polypes. 

When  we  turn  our  inquiries  in  another  direc- 
tion, we  find  that  the  study  and  knowledge  of 
the  electric  power  has  not  deserted  the  country 
of  Franklin.  This  mighty  agent,  before  which 
men  trembled  in  former  ages,  believing,  in  their 
alarm,  that  Jove  was  wielding  his  bolts,  or  'that 
spirits  were  riding  the  Northern  light,'  —  has 
become,  in  philosophic  hands,  the  docile  mes- 
senger of  thought  over  our  vast  country,  and 
the  faithful  monitor  of  danger  in  our  cities,  and 
seems  about  to  reveal  the  very  measure  of  its 
velocity  to  the  persevering  interrogations  of 
members  of  this  Academy. 

I  should  weary  you  with  detail,  were  I  to 
recount  the  various  contributions  made  among 
us  to  mathematical,  chemical,  economical,  me- 
chanic, and  microscopic  science,  and  to  the 
natural  history  of  the  globe  and  of  its  inhabi- 
tants. I  might  say  that  the  tornado  which  last 
year  swept  over  a  neighboring  district,  has  left 
on  our  pages  an  impress  more  minute  than  ever 
whirlwind  left  before.  I  might  say  that  the 
forthcoming  nautical  almanac,  the  joint  and 


382  ADDRESS    BEFORE    THE    AMERICAN 

arduous  production  of  our  mathematicians,  will 
stand  in  the  foremost  rank  of  similar  authori- 
ties. I  might  bring  before  you  the  perfected 
turbine  wheel,  and  the  elaborate  cordage  ma- 
chinery, as  examples  of  the  mechanical  ability 
and  inventive  genius  of  our  academicians ;  and 
I  might  cite  many  instances  of  energetic  coope- 
ration with  other  bodies,  in  the  magnetic  ob- 
servations, in  meteorology,  in  the  coast  survey, 
and  in  the  general  advancement  of  geographi- 
cal and  philosophic  knowledge. 

Conspicuous  above  other  sciences,  for  the 
vastness  of  its  objects,  and  the  amount  of  in- 
tellectual effort  which  it  has  called  into  being, 
stands  Astronomy,  one  of  the  earliest,  the  most 
difficult,  and  most  successful  studies  of  the  hu- 
man mind.  For  many  years  the  discoveries  of 
its  observers,  and  the  results  of  its  analysts, 
have,  by  the  common  consent  of  central  and 
northern  Europe,  been  chronicled  in  one  place 
in  the  city  of  Altona,  in  the  astronomical  jour- 
nal of  the  eminent  Professor  Schumacher.  But 
Schumacher  is  dead,  and  his  divided  mantle 
has  fallen  upon  the  shoulders  of  more  than  one 
competent  successor.  The  only  journal  in  the 


ACADEMY    OF    ARTS    AND    SCIENCES.  383 

English  language,  now  devoted  to  pure  astro- 
nomical science,  regularly  reporting,  with  dis- 
criminating exactness,  the  advances  made  in 
that  department  of  knowledge,  and  enriched  by 
contributions  from  both  sides  of  the  Atlantic, 
as  well  as  from  its  own  editor,  is  now  published 
in  this  country,  and  issues  periodically  from  the 
press  of  Cambridge  in  Massachusetts. 

It  has  not  been  in  vain  that  public  liberality 
has  provided  our  University  with  instruments 
capable  of  penetrating  the  depths  of  space.  It 
has  found  in  that  place  eyes  adequate  to  per- 
ceive, and  minds  competent  to  analyze,  the 
abstruser  revelations  of  astronomical  science. 
The  meetings  of  this  Academy  have  heard  the 
announcement  of  new  celestial  bodies,  and  the 
assignment  of  unexpected  laws  to  others  al- 
ready familiar  to  the  European  world.  Who 
is  there,  from  the  schoolboy  to  the  sage,  who 
has  not  dwelt  and  gazed  and  speculated  on  the 
mysterious  ring  that  surrounds  the  planet  Sat- 
urn ?  Who  has  not  wondered  at  this  excep- 
tional feature  of  the  known  universe,  and  plant- 
ed himself  in  imagination  on  the  surface  of  that 
distant  sphere,  that  he  might  seem  to  contem- 


384  ADDRESS    BEFORE    THE   AMERICAN 

plate  the  radiant  arch  that  spanned  its  unknown 
firmament  ?  Yet  this  remaining  anomaly  of  the 
visible  creation,  this  marvel  and  study  of  mod- 
ern astronomy,  has  been  destined  to  reveal  its 
structure  at  our  own  observatory.  And  the 
necessity  of  its  fluid  nature,  and  the  laws  by 
which  it  is  sustained,  have  been  deduced  from 
the  observations,  and  established  by  the  pro- 
found analysis  of  our  own  astronomers. 

Need  I  call  up  before  this  audience  the  re- 
cent fame  of  that  far  ulterior  planet,  which, 
since  the  creation  of  the  world,  has  held  its  dim 
and  undetected  course  around  the  verge  of  our 
solar  system,  until  at  length  its  remote  presence 
so  weighed  upon  the  instructed  sense  of  the 
Parisian  philosopher,  that  it  was  felt  and  known 
even  before  it  was  seen?  And  need  I  say  that 
this  object  of  absorbing  interest,  this  wonder  of 
its  time,  after  justifying  in  some  measure  the 
rival  claims  to  its  discovery  of  the  three  most 
enlightened  nations  of  Europe,  came  at  last  to 
receive  the  determination  of  its  true  orbit,  posi- 
tion, mass  and  motion  from  the  geometers  of 
our  own  Academy  ? 

I  have  said  enough  to  show,  that  the  Ameri- 


ACADEMY    OF    ARTS    AND    SCIENCES.          385 

can  Academy  of  Arts  and  Sciences  has  earned 
for  itself  a  position  among  similar  institutions 
of  the  world ;  and  although,  from  the  necessary 
limits  of  the  occasion,  I  have  not  been  able  to 
take  fitting  notice  of  other  investigations  made 
here  for  the  advancement  of  knowledge  and 
other  worthy  achievements  in  the  parallel  walks 
of  literature,  yet  without  arrogance  I  might  as- 
sert that,  in  the  different  sections  of  this  Acade- 
my, embracing  the  great  departments  of  modern 
research  and  cultivation,  men  are  now  found 
competent  to  perceive  truth,  and  qualified  to 
return  light,  on  the  varied  objects  of  human 
science. 

It  is  not  necessary  to  say,  that  the  meetings 
of  such  a  body  afford  a  nucleus,  around  which 
are  attracted  and  concentrated  the  contributions 
of  most  of  our  scientific  men.  And  the  regu- 
larly published  proceedings  of  this  body  are  the 
vehicle  through  which  are  given  to  the  world 
the  results  of  their  labors. 

It  ought  not  then  to  be  said  that,  in  this 
enlightened  community,  the  efforts  of  so  active 
and  efficient  an  institution  should  be  embarrass- 
ed by  financial  deficiencies.  Yet  such  is  the 
25 


386     ADDRESS  BEFORE  THE  AMERICAN 

uniform  excess  of  its  expenditures  over  its  lim- 
ited income,  that  the  Academy  is  not  able  to 
procure  the  books  wanted  for  the  information 
of  its  members,  nor  to  issue  the  publications 
which  should  give  utterance  to  its  own  investi- 
gations. So  far  from  enjoying  the  promptness 
and  amplitude  of  appearance  which  attend  the 
productions  of  similar  institutions  abroad,  it  has 
happened,  more  than  once,  that  the  discoveries 
of  our  scientific  men  have  had  to  wait,  until 
they  were  actually  superseded  by  the  same  dis- 
coveries abroad,  because  the  printed  pages  and 
the  illustrations  of  the  engraver  could  not  be 
commanded  at  the  requisite  time. 

As  a  nation  we  are  proud  of  whatever  con- 
tributes to  our  national  glory.  We  are  boastful 
of  our  growth,  our  political  progress,  our  victo- 
ries, our  annexations.  We  are  proverbially  sen- 
sitive, even  in  small  matters,  to  questions  of 
precedence  and  subordination,  and  we  give  our 
undivided  sympathy  even  to  a  national  contest 
of  locksmiths.  The  triumph  of  nautical  skill 
in  a  distant  boat  race  binds  this  Union  more 
firmly  together,  by  the  common  thrill  of  exulta- 
tion which  vibrates  from  Maine  to  Texas. 


ACADEMY    OF    ARTS    AND    SCIENCES.          387 

Have  we  then  no  place  for  the  rising  star  of 
science  ?  Shall  we  avert  our  eyes  from  the 
dawning  light,  because  its  rays  do  not  fall  on 
us  from  the  accustomed  east?  Have  we  no 
encouragement  for  those,  our  countrymen,  to 
whom  the  old  world  is  beginning  to  yield  its 
reluctant  honors  ?  Are  we  incapable  of  appre- 
ciating the  value  of  scientific  progress,  and  the 
importance  that  our  own  country  should  not  be 
last  in  the  general  march  of  improvement  which 
characterizes  the  present  age  ?  Such  has  not 
been  the  character  and  usage  of  this  our  city. 
Such  could  not  have  been  the  expectation  of 
those  who,  in  adverse  times,  planted  and  nour- 
ished among  us  seeds  capable  of  a  redundant 
harvest. 

I  have  thus,  ladies  and  gentlemen,  endeavor- 
ed to  present  to  your  favorable  notice,  the  char- 
acter and  claims  of  the  Academy  of  Arts  and 
Sciences.  In  the  course  of  lectures  which  is  to 
follow,  the  Academy  will  speak  for  itself.  I  am 
aware  that  it  is  presumptuous  for  one  absorbed 
in  the  cares  of  a  responsible  profession,  who 
has  added  little  to  the  common  storehouse  of 
indigenous  science,  to  appear  as  the  advocate 


388      ADDRESS    BEFORE    AMERICAN    ACADEMY. 

and  representative  of  so  distinguished  a  body. 
But  I  am  impressed  with  the  importance  of  the 
occasion,  and  obey  the  commands  which  have 
been  laid  upon  me ;  and  I  will  shelter  myself 
under  the  belief,  that  it  may  sometimes  be  per- 
mitted, even  to  the  drone  in  the  hive,  to  cause 
the  air  to  vibrate  in  honor  of  the  labors  of  his 
more  efficient  colleagues. 


INDEX. 


Page 

Page 

ABSTINENCE  in  Diet, 

144 

Cochituate  Water, 

318 

Academy  American,  Ad- 

Cofiee, 

289 

dress, 

359 

Colchicum, 

143 

Acute  Rheumatism, 

24 

Cutaneous  Diseases, 

24 

Amphoric  Resonance, 

230 

Ajiatomy  and  Surgery, 

94 

Definition  of  Medicine, 

64 

Andre,  Major, 

190 

Detrimental  Practice, 

40 

Angina  Pectoris, 

22 

Detrimental  Remedies, 

82 

Ascarides, 

50 

Diagnosis, 

67 

Auburn,  Mount,         171, 

192 

Earle,  Sir  James, 

149 

Blane,  Sir  Gilbert, 

37 

Education,  Medical, 

91 

Borromeo,  Carlo, 

187 

Edward  I.  King, 

175 

Botanic  Practitioners, 

105 

Egyptian  Medicine, 

254 

Bowditch,  Nathaniel, 

374 

Electricity, 

381 

Burial  of  the  Dead, 

171 

Elephant,  frozen, 

185 

Burns  and  Scalds, 

146 

Epilepsy, 

21 

Erysipelas, 

12 

Causes,  Removal  of, 

57 

Esculapius, 

246 

Chalk  Stones, 

135 

Etiology, 

93 

Charles  I.  King, 

178 

Exact  Sciences, 

59 

Chemistry, 

92 

Exaggeration,  Medical, 

95 

Clot  Bey, 

76 

Expectant  Practice, 

103 

390 

INDEX. 

Fire,  Injuries  by, 

146 

Metastatic  Diseases, 

23 

Mount  Auburn,          171, 

192 

Gout,                            49, 

132 

Mucuna  Pruriens, 

266 

Grecian  Medicine, 

342 

Mummies,  Egyptian, 

187 

Harmony  among  Physi- 

Neptune, Planet, 

384 

cians, 

123 

Nomenclature, 

237 

Henry  VIII.  King, 

183 

Numerical  Method, 

34 

History  of  Medicine, 

838 

Homoeopathy, 

101 

Organic  Remains, 

380 

Hooping  Cough, 

10 

Paroxysmal  Diseases, 

21 

Incurable  Diseases, 

88 

Partridge,  Poison  of, 

272 

Inefficacy  of  Treatment, 

75 

Pathology, 

93 

Pestilential  Epidemics,  25.  54 

Kentish,  Mr. 

148 

Pharmacopoeia     Ameri- 

Kinglake, Dr. 

148 

can, 

231 

Kings,  Relics  of, 

178 

Pickering,  John, 

375 

Plague  at  Cairo, 

76 

Lead,  Exposure  to, 

316 

Pneumothorax, 

195 

Lead  Pipes  for  Water, 

315 

Practical  Medicine, 

62 

Lectures,  Medical, 

97 

Precocious  Habits, 

111 

Louis, 

34 

Priestly  Medicine, 

351 

Private  Schools, 

98 

Materia  Medica, 

93 

Measles,                        11 

,43 

Quackery,                   108, 

124 

Medical  Education, 

91 

Medical  Profession, 

111 

Rabbits,  Experiments  on, 

152 

Medical  Reasoning, 

29 

Rational  Practice, 

35 

Metallic  Tinkling,      197, 

224 

Remedies, 

56 

391 


Remedies,  excessive, 

82 

Textures,    Susceptibility 

Rheumatism,  Acute, 

24 

of, 

269 

Theories  in  Medicine, 

118 

Scarlet  Fever, 

11 

Thomsonian  Sect, 

105 

Self-limited  Diseases, 

1 

Tobacco,  History  of, 

323 

Small  Pox, 

12 

Treatment  of  Disease, 

59 

Success  of  Treatment, 

26 

Typhoid  Fever, 

14 

Symptoms,  prescribing  for 

,  79 

Syphilis, 

42 

Vinous  Liquors, 

188 

Tanquerel  on  Lead, 

318 

Watch,  Illustration  by, 

69 

Tea, 

297 

BOSTON,  135  WASHINGTON  STBKJBT. 
NOVEMBKB,  1854. 

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from  which  it  was  borrowed. 


lecnearrmn 
MAR  03  1995 


mi 


meir  stock  of  Miscellaneous  Books  is  very  complete,  and  they  respectfully 
solicit  orders  from  CITY  AND  COUNTRY  LIBRARIES. 


